Think Beyond The Label Jobs

The Workers Compensation Claims Representative works independently under moderate supervision to determine coverage and investigate, analyze, negotiate, and settle claims. The role prepares reports on investigation, settlements, denials of claims, individual evaluation of involved parties, facilitates and supports the execution of action plans and delivers quality customer services in a moderate complex work environment and informs claimants as needed. Determines if proper coverage exists for the type of claim assigned and determines the value of the physical damage of property, automobiles, or injuries through use of appropriate tools. Investigates thoroughly to obtain relevant facts on claims coverage, liability, legal climate, potential exposure, damages etc. and makes decisions, where appropriate, on claim resolution. Gathers facts by contacting involved parties to determine legal responsibility, damage causation, reviews data regularly and tracks and reports trends. Establishes and reviews proper reserves for each claim based on thorough investigation, evaluation, and experience. Ensures timely & accurate reserve practices are being followed to cultivate favorable reserve adequacy results. Sets reserves within authority limits and recommends reserve changes to team leader, processes financial transactions such as stop pays, reissues, payment transfers, etc. within guidelines. Prepares reports on investigation, settlements, denials of claims, individual evaluation of involved parties etc. Monitors ongoing case development for appropriateness and obtains necessary documentation to support claims evaluation. Recognizes claim file exposures, escalates, and completes appropriate reports so that the claim status is clearly documented. Refers claims exceeding authority to appropriate leader or complex claims specialist with recommendations. Maintains effective and ongoing communications with the insured, claimants, agents, attorneys, insurance companies, representatives, vendors, and company personnel. Establishes and maintains positive relationships with internal and external customers resolving conflict around disputed benefits and providing excellent customer service. For field roles only: Travels as often as needed including regular utilization of assigned fleet vehicle in order to cover assigned territory. This may involve traveling on short notice or other daily driving duties as assigned. 2+ years of Claims Handling experience. Bachelor's degree in business administration, finance, or any other field and/or commensurate work experience. For field roles only: Valid driver's license and a driving record that conforms to company standards.