CLAIMS REPRESENTATIVE SR

Work Where You Matter Company Overview We are hiring a Senior Claims Representative, Workers’ Compensation to independently investigate, evaluate, negotiate, and resolve complex claims, exercising sound judgment within established authority and with limited supervision. Job Details Timely conduct interviews with injured employees, customers, store personnel and medical care providers within 24 hours of receiving reported incident to evaluate facts regarding compensability of a claim under the state requirements. Maintain contact with appropriate parties throughout life of file to manage payment of appropriate benefits and mitigate exposure. Reserve claim for expected exposure, and timely document claim notes within claim system, maintaining updated action plan. 30% Timely coordinate with injured employee and store personnel regarding medical documentation supporting and facilitate return to work and light duty return to work. 10% Manage requests for authorization of medical care and oversee facilitation of medical care to ensure timely, appropriate, and related treatment for the work injury. 10% Utilize professional judgment and experience to reserve, handle and resolve complex claims within authority and evaluate and make recommendations for reserves and action plan for resolution of claims exceeding authority. 25% Provide direction to defense attorneys for claims in litigation, medical case managers and private investigators as appropriate for assigned claims. 10% Develop and maintain proactive strategic plan of action for the management and resolution of claims for the life of the file. 10% Maintain a working knowledge of multiple state Workers’ Compensation and statutes and maintain applicable current state licensing requirements. 5% Qualifications Customer service oriented and works well in a team environment. Excellent written and verbal communication skills. Strong organizational skills and the ability to prioritize complex claims. Must be detail oriented and able to meet deadlines. Ability to handle confrontational situations in a mature and professional manner. Working knowledge of Microsoft office programs and ability to type 40 wpm. Advanced knowledge of medical and legal terminology. Previous Workers’ Compensation claim handling experience. 5+ years of experience handling complex and/or litigated workers’ compensation claims from inception through final resolution required, including investigation, evaluation, management of benefits, litigation management, and settlement execution. The salary range for this position is $70,000-$76,000, with final compensation determined by factors including education, experience, skills, and qualifications. This role is also eligible for a company performance bonus. #J-18808-Ljbffr ∙ Elijah House Foundation