Senior Claims Representative

Responsibilities Execute the Company’s ecovery® Return to Wellness philosophy and business model Manage all aspects of assigned complex workers’ compensation claims, including verifying coverage, investigating, managing, and resolving claims Establish and maintain accurate case reserves with authority up to $75,000 Complete proactive ongoing claim management activities and maintain regular contact with injured workers, agents, customers, and co-workers Investigate claims, assess coverage, determine injury nature and extent, make compensability determinations, and identify subrogation potential Prepare reports and forms required by jurisdictional regulations and Company procedures Prepare claim status reports for customers, agents, underwriters, reinsurers, and others Attend point-of-sale presentations and claim review meetings Manage Return to Wellness initiatives and establish, follow, and achieve return-to-work guidelines Attend monthly large account team meetings and discuss results, profitability, and renewal strategy Assist with company projects and participate in insurance-related professional development events Requirements Bachelor’s degree and a minimum of five years’ experience in workers’ compensation claims management, or a minimum of ten years working in a professional claims capacity in workers’ compensation without a degree Advanced certification or training preferred Comprehensive knowledge of applicable state laws and industry standards Ability to independently attend insurance and industry/business functions Proficiency in Microsoft Office computer applications Ability to learn new computer software applications Advanced analytical ability to analyze and interpret information and make appropriate decisions regarding claims payments Excellent organization and time management skills Excellent negotiation skills Attention to detail in processing information, establishing priorities, and meeting deadlines Excellent analytical and problem-solving skills Ability to assess urgency and importance and take appropriate action Empathic listening and ability to build mutual understanding and trust Effective and professional verbal and written communication with various constituencies and organizational levels Core Competencies Demonstrates expertise in managing complex workers' compensation claims, including coverage verification, claims investigation, and resolution. Proficient in maintaining case reserves, preparing regulatory reports, and executing return-to-work initiatives while ensuring compliance with state laws and industry standards. Highest-signal resume keywords Workers' Compensation Claims Management Case Reserve Management Regulatory Reporting Advanced Analytical Skills Negotiation Skills Hard Skills Claims Investigation Coverage Assessment Compensability Determination Subrogation Identification Report Preparation Return-to-Work Guidelines Microsoft Office Proficiency Analytical Problem-Solving Soft Skills Excellent Organization Time Management Empathic Listening Effective Communication Certifications & Qualifications Advanced Certification or Training Industry Keywords Workers' Compensation State Laws Industry Standards Claims Management Insurance Functions #J-18808-Ljbffr