Claims Representative Workers Compensation

Job Title: Claims Representative - Workers Compensation
Location (On-site Remote or Hybrid): US (remote)
Contract Duration: Contract until 12/26/2025

DESCRIPTION:

• Work location: Remote across US for candidates with both CO & AZ experience.
• Any specific skill/ certification/ license: Colorado WC jurisdiction proficiency / AZ lisc. or certification is a plus
• Years of experience: 2 yrs or more of direct WC claim handling.

PRIMARY PURPOSE: To process low level workers compensation claims to determine benefits due; to ensure ongoing adjudication of claims within company standards and industry best practices; and to identify subrogation of claims and negotiate settlements with general supervision.

ESSENTIAL FUNCTIONS and RESPONSIBILITIES

• Processes low level workers compensation claims determining compensability and benefits due on long term indemnity claims monitors reserve accuracy and files necessary documentation with state agency.
• Develops and coordinates low level workers compensation claims action plans to resolution return-to-work efforts and approves claim payments.
• Approves and processes assigned claims determines benefits due and administers action plan pursuant to the claim or client contract.
• Administers subrogation of claims and negotiates settlements.
• Communicates claim action with claimant and client.
• Ensures claim files are properly documented and claims coding is correct.
• May process low-level lifetime medical and/or defined period medical claims which include state and physician filings and decisions on appropriate treatments recommended by utilization review.
• Maintains professional client relationships.

ADDITIONAL FUNCTIONS and RESPONSIBILITIES

• Performs other duties as assigned.
• Supports the organizations quality program(s).
• Travels as required.

QUALIFICATIONS
Education & Licensing
Bachelors degree from an accredited college or university preferred.

Experience
Two (2) years of claims management experience or equivalent combination of education and experience or successful completion of Claims Representative training required.

Skills & Knowledge

• Developing knowledge of regulations offsets and deductions disability duration medical management practices and Social Security and Medicare application procedure as applicable to line of business
• Excellent oral and written communication including presentation skills
• PC literate including Microsoft Office products
• Analytical and interpretive skills
• Strong organizational skills
• Good interpersonal skills
• Ability to work in a team environment
• Ability to meet or exceed Service Expectations