Claims Representative – Workers Compensation Training Program
Job Description:
- Attend and complete the designated claims professional training program
- Adjust various levels of workers’ compensation claims under close supervision
- Process and respond to incoming mail, emails, and other claim-related documents according to claim status
- Communicate with injured workers, insureds/employers, medical providers, attorneys, and carrier representatives through telephone, video conference, and email
- Investigate new and existing claims by gathering medical records, employer reports, and witness statements
- Investigate employer/employee relationships, policy verification, coverage, potential subrogation issues, and fraud indicators
- Determine coverage, compensability, and appropriate benefits according to jurisdictional guidelines and carrier program requirements
- Document claims files and properly code claim activity
- Prepare detailed reports documenting findings and recommendations
- Administer indemnity and medical claim benefits by maintaining calendared claim-related action items and ensuring state compliance
- Participate in virtual and/or in-person meetings, claim reviews, and business functions as needed for training and claim discussions
- Complete a 4-week concept-based learning and professional training program followed by dedicated onboarding and on-the-job training
- Work with an assigned mentor and manager for career guidance and support
Requirements:
- High school diploma or GED required
- Bachelor’s degree preferred
- 2 years of customer service experience and/or combination of education and experience
- Strong communication skills
- Empathy
- Ability to multitask
- Accountability
- Structured thinking
- Ambition
- Ability to learn quickly and adapt
- Ability to collaborate with teams
- 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
- Ability to meet deadlines
- Computer keyboarding ability
- Hearing, vision, and talking abilities
- Ability to participate in virtual and/or in-person meetings and business functions as needed
Benefits:
- Career development and promotional growth opportunities through increasing responsibilities
- Medical insurance
- Dental insurance
- Vision insurance
- 401(k) plan
- 401(k) matching
- Paid time off (PTO)
- Disability insurance
- Life insurance
- Employee assistance
- Flexible spending account or health savings account
- Other additional voluntary benefits
- Reasonable accommodations when applicable and appropriate