Workers' Comp Claim Representative II - CA/CO/AZ

This is an entry level to advanced level claim handler position that handles workers' compensation claims. The representative will verify coverage, determine compensability, facilitate return to work, and negotiate settlements. The position requires a bachelor's degree and relevant experience, with certification or progress toward certification highly preferred.

Requirements

• Verifies workers' compensation coverage of employers and injured employees.
• Determines compensability under workers' compensation by thorough investigation of the claim.
• Determines causal relationship between the reported injury and the incident to ensure appropriate payment of benefits.
• Facilitates return to work for the injured employee.
• Establishes timely and appropriate reserves based on the profile of the claim within given authority based on anticipated financial exposure.
• Documents specifics of claims with potential for subrogation recovery, including amount of potential recovery monies.
• Manages medical bills for non-indemnity and indemnity claims directly associated with the claimed injury.
• Concludes and closes files following resolution of claims to meet internal performance standards while complying with state legislation to avoid penalties and manage expenses.
• Negotiates settlements with attorneys or injured parties within given authority at the earliest possible point to bring cases to final disposition.
• Works closely with manager on complex files or files above settlement/reserve authority.
• Manages outside vendors to ensure cost containment efforts.
• Establishes and maintains effective working relationships with all internal and external customers.
• Stays abreast of changes in workers' compensation statutes, case law and rehabilitation efforts/advancements in order to accurately interpret and apply relevant laws.
• Administers complex claims and catastrophic exposures within authority, including claims from dedicated large accounts.
• Exercises independent judgment to settle cases prior to mediation or litigation.
• Actively participates in agent/client relationship management.
• Assists in mentoring team members.
• Mentors team members.
• Conducts audits of claim files.
• Acts as a back up for team leader.
• Coordinates special projects.

Benefits

• Generous Paid Time Off
• 401k Matching
• Retirement Plan
• Health Insurance
• Dental Insurance
• Vision Insurance
• Life Insurance
• Disability Insurance
• Professional Development Opportunities