Claims Representative - Workers' Compensation

Role: The Claim Representative is responsible for managing workers’ compensation claims from investigation to resolution, ensuring compliance with laws and policies. Key Responsibilities Investigate, evaluate, and manage claims efficiently and fairly. Serve as the primary contact for injured workers, employers, and medical providers, maintaining clear communication. Conduct thorough investigations by gathering statements, reviewing medical records, and analyzing reports. Make prompt decisions on claim acceptance, denial, or settlement based on case facts and legal guidelines. Maintain detailed documentation of all activities and communications. Monitor and control claim costs, including medical and legal expenses, while establishing appropriate reserves. Ensure compliance with relevant workers’ compensation laws and regulations. Provide excellent customer service by addressing inquiries and updating claim statuses. Collaborate with legal, medical, and risk management teams to achieve optimal outcomes. Qualifications & Skills: Strong investigative, decision-making, and communication skills; knowledge of workers’ compensation laws; detail-oriented; ability to work collaboratively; commitment to compliance and customer service. #J-18808-Ljbffr Alpha Home Health and Hospice