Workers Compensation Claims Representative

Job Description

Job Description

We are looking for a Workers Compensation Claims Representative to support a Financial Services organization in Saint Paul, Minnesota. This Long-term Contract opportunity is ideal for someone who can manage workers’ compensation claim activity with accuracy, sound judgment, and strong communication across members, claimants, and medical providers. The role focuses on reviewing claim-related documentation, coordinating payments, and escalating complex issues when compensability, treatment, or exposure requires further evaluation.

Responsibilities:

• Assess incoming reports, notices, and supporting documentation related to workplace injuries and occupational illnesses, and process assigned claims in accordance with established guidelines.

• Review medical and related billing from providers such as physicians, clinics, hospitals, and pharmacies, and authorize eligible payments for claims that do not involve indemnity benefits.

• Evaluate reimbursement requests from injured employees for travel and out-of-pocket medical expenses connected to accepted work-related conditions, and approve payments when appropriate.

• Partner with nurse case management and other clinical resources to clarify questionable injury circumstances, treatment plans, or the need for additional medical review.

• Secure prior medical documentation when needed to support claim handling decisions or to assist physician and nurse consultants in evaluating treatment history.

• Set and maintain claim reserves in a timely manner, and obtain management approval before making reserve increases or payments above delegated authority limits.

• Keep claimants and member organizations informed of claim progress, payment activity, and key processing updates through clear and effective communication.

• Escalate files involving questionable compensability, potential lost-time exposure, subrogation opportunities, restitution matters, or possible property and casualty implications to the claims manager for further direction.

• Prepare and submit restitution-related affidavits when applicable, and monitor follow-up actions to support recovery efforts.

*Please note that all candidates are required to provide 2 recent supervisor or manager references in order to be considered for employment.

 

Please submit your resume and call View phone number on ziprecruiter.com for review and consideration.

• Experience handling workers’ compensation claims, insurance follow-up, or related claims administration in a regulated environment.
• Knowledge of medical billing, patient accounting, payment review, and invoice processing tied to occupational injury claims.
• Ability to interpret claim documentation, evaluate reimbursement requests, and apply sound judgment when determining when issues should be escalated.
• Familiarity with preauthorization processes, medical record review, and coordination with clinical professionals such as nurse case managers or physician consultants.
• Strong data entry skills with the ability to maintain accuracy in a high-volume processing environment.
• Effective verbal and written communication skills for interacting with claimants, members, healthcare providers, and internal leadership.
• Strong organizational skills with the ability to manage multiple claim files, deadlines, and payment activities simultaneously.