Claims Associate Workers Compensation

PRIMARY PURPOSE:

• To analyze reported lower-level workers compensation claims to determine benefits due; and to ensure ongoing adjudication of claims within company standards and industry best practices.

ESSENTIAL FUNCTIONS and RESPONSIBILITIES

• Adjusts medical-only claims and minor lost-time workers compensation claims under close supervision.
• Supports other claims representatives examiners and leads with larger or more complex claims as necessary.
• Processes workers compensation claims determining compensability and benefits due; monitors reserve accuracy and files necessary documentation with state agency.
• Communicates claim action/processing with claimant client and appropriate medical contact.
• Ensures claim files are properly documented and claims coding is correct.
• May process routine payments and prescriptions and status reports for lifetime medical claims and/or defined period medical claims.
• Maintains professional client relationships.

ADDITIONAL FUNCTIONS and RESPONSIBILITIES

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

QUALIFICATION

• Education & LicensingHigh school diploma or GED required.
• Licenses as required.
• ExperienceOne (1) year of general office experience or equivalent combination of education and experience required.
• Claims industry experience preferred.
• Skills & Knowledge Excellent oral and written communication 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 Performance Competencies

WORK ENVIRONMENT

• When applicable and appropriate consideration will be given to reasonable accommodations.
• Mental: Clear and conceptual thinking ability; excellent judgment troubleshooting problem solving analysis and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines Physical: Computer keyboarding travel as required Auditory/Visual: Hearing vision and talking

NOTE

• Credit security clearance confirmed via a background credit check is required for this position.
• The statements contained in this document are intended to describe the general nature and level of work being performed by a colleague assigned to this description.
• They are not intended to constitute a comprehensive list of functions duties or local variances.
• Management retains the discretion to add or to change the duties of the position at any time..