Worker's Compensation Maintenance Claims Representative

Handle maintenance files, receiving and handling all WC claims involving lifetime exposures of lost time and/or medical treatment. Review medical bills, issue indemnity checks, apply medical treatment guidelines. Tasks include, but are not limited to: diary management, mail management, setting reserves, evaluation of compensability of treatment, annual reporting, age changes, activity checks, IME, UR, or Peer Reviews and other duties as assigned. Communicate directly with insureds, claimants, medical providers and others by telephone and through written correspondence. Occasionally settle smaller claims. Handle all claim assignments in accordance with quality program criteria. Follow directives and instructions from the Claims Supervisor. Performs other duties as assigned. Conforms with all corporate policies and procedures. Requirements Bachelor's Degree preferred or equivalent experience; Insurance coursework is helpful. 2-3 years previous claims experience preferred. NY claims experience preferred; knowledge of other Northeastern states helpful. Required to obtain your license(s) as an adjuster in the state(s) in which you are assigned to adjust claims. Licensing must be obtained within the timeframe set forth by the Company and must be maintained as needed throughout your employment. Core Competencies Demonstrates expertise in handling workers' compensation claims, including medical bill review, indemnity checks, and compliance with treatment guidelines. Proficient in communication with various stakeholders and managing claim assignments effectively. Highest-signal resume keywords Workers' Compensation Claims Management Medical Bill Review Claims Adjuster License Diary Management Claims Communication ATS Optimization Keywords Hard Skills Claims Processing Indemnity Check Issuance Compensability Evaluation Activity Checks Annual Reporting Medical Treatment Guidelines Reserve Setting IME Management UR Management Peer Review Management Soft Skills Effective Communication Attention to Detail Organizational Skills Problem-Solving Customer Service Certifications & Qualifications Claims Adjuster License Industry Keywords Northeastern States Claims Experience Insurance Coursework Quality Program Criteria Corporate Policies Compliance #J-18808-Ljbffr Jobtailor