Claims Specialist III – WC
Job Description:
• Review claim assignments to determine policy coverage and compensability
• Conduct interviews and research facts of a claim
• Establish rapport with stakeholders throughout the recovery process
• Analyze medical records and determine compensability
• Propose vocational support when appropriate
• Identify and document subrogation potential
• Comply with Medicare Secondary Payor requirements
• Periodically assess claim file reserves and risk factors
• Execute technical claim handling functions
• Engage in direct negotiation and mediation according to jurisdiction
• Participate in continuing education opportunities
Requirements:
• High school diploma required; Bachelor’s degree preferred
• 5+ years of general work experience
• 10+ years of workers’ compensation claims handling experience
• Meet state licensing requirements to handle claims
• Within 1 year of hire, complete the Workers’ Recovery Professional (WRP) certification program
• Within 3 years of hire, complete the Senior Workers’ Compensation Law Associate (SCLA) designation program
• Proficient knowledge of insurance, medical and legal concepts
Benefits:
• Annual incentive compensation
• Medical, dental, vision & life insurance
• Accident, critical Illness & short-term disability insurance
• Retirement plans with employer contributions
• Generous time-off program
• Programs designed to support the employee well-being and financial security.
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• Review claim assignments to determine policy coverage and compensability
• Conduct interviews and research facts of a claim
• Establish rapport with stakeholders throughout the recovery process
• Analyze medical records and determine compensability
• Propose vocational support when appropriate
• Identify and document subrogation potential
• Comply with Medicare Secondary Payor requirements
• Periodically assess claim file reserves and risk factors
• Execute technical claim handling functions
• Engage in direct negotiation and mediation according to jurisdiction
• Participate in continuing education opportunities
Requirements:
• High school diploma required; Bachelor’s degree preferred
• 5+ years of general work experience
• 10+ years of workers’ compensation claims handling experience
• Meet state licensing requirements to handle claims
• Within 1 year of hire, complete the Workers’ Recovery Professional (WRP) certification program
• Within 3 years of hire, complete the Senior Workers’ Compensation Law Associate (SCLA) designation program
• Proficient knowledge of insurance, medical and legal concepts
Benefits:
• Annual incentive compensation
• Medical, dental, vision & life insurance
• Accident, critical Illness & short-term disability insurance
• Retirement plans with employer contributions
• Generous time-off program
• Programs designed to support the employee well-being and financial security.
Apply tot his job
Apply To this Job