Talent.com
Emergent Holdings
Claim Representative II - NV/CA experience requiredEmergent Holdings • Phoenix, AZ, United States
Claim Representative II - NV/CA experience required

Claim Representative II - NV/CA experience required

Emergent Holdings • Phoenix, AZ, United States
Hace 7 días
Tipo de contrato
  • A tiempo completo
Descripción del trabajo

Claim Representative II

This is the intermediate level of the claim handler career path. Handles moderate difficult claims. Exercises progressively more discretion in the determination of compensability of claims. Considers many factors in the determination claim reserves. Negotiates and settles claims within given authority. Must have CA/NV experience.

Claim Representative II:

  • Verifies workers' compensation coverage of employers and injured employees.
  • Determines compensability under workers' compensation by thorough investigation of the claim.
  • Determines causal relationship between the reported injury and the incident to ensure appropriate payment of benefits.
  • Facilitates return to work for the injured employee.
  • Establishes timely and appropriate reserves based on the profile of the claim within given authority based on anticipated financial exposure.
  • Documents specifics of claims with potential for subrogation recovery, including amount of potential recovery monies.
  • Manages medical bills for non-indemnity and indemnity claims directly associated with the claimed injury. Approves payment based on knowledge of the treatment plan and medical support showing relationship of treatment to the injury.
  • Concludes and closes files following resolution of claims to meet internal performance standards while complying with state legislation to avoid penalties and manage expenses.
  • Negotiates settlements with attorneys or injured parties within given authority at the earliest possible point to bring cases to final disposition.
  • Works closely with manager on complex files or files above settlement/reserve authority.
  • Manages outside vendors to ensure cost containment efforts.
  • Establishes and maintains effective working relationships with all internal and external customers.
  • Stays abreast of changes in workers' compensation statutes, case law, and rehabilitation efforts/advancements to accurately interpret and apply relevant laws.

Claim Representative II:

  • Administers complex claims and catastrophic exposures within authority, including claims from dedicated large accounts.
  • Exercises independent judgment to settle cases prior to mediation or litigation.
  • Actively participates in agent/client relationship management.
  • Assists in mentoring team members.

This position description identifies the responsibilities and tasks typically associated with the performance of the position. Other relevant essential functions may be required.

Employment Qualifications

Education or equivalent experience:

Three years' experience in a workers' compensation claims environment which provides the necessary skills, knowledge, and abilities, such as experience in reviewing, investigating, and closing workers' compensation claims. Experience of handling claims in multiple jurisdictions preferred. Bilingual skills preferred.

Or

One year of AF Group Claims Representative I experience that includes handling of difficult or complex claims.

Skills/Knowledge/Abilities (SKA) required:

  • Ability to make independent decisions.
  • Ability to solve complex problems.

Working conditions:

Work is performed in an office setting with no unusual hazards. Minimal travel required.

Pay range: Actual compensation decision relies on the consideration of internal equity, candidate's skills and professional experience, geographic location, market, and other potential factors. It is not standard practice for an offer to be at or near the top of the range, and therefore a reasonable estimate for this role is between $56,700 and $4,900.

The qualifications listed above are intended to represent the minimum education, experience, skills, knowledge, and ability levels associated with performing the duties and responsibilities contained in this job description.

We are an Equal Opportunity Employer. Diversity is valued and we will not tolerate discrimination or harassment in any form. Candidates for the position stated above are hired on an "at will" basis. Nothing herein is intended to create a contract.

Crear una alerta de empleo para esta búsqueda

Claim Representative II - NV/CA experience required • Phoenix, AZ, United States

Ofertas similares

Claims Representative - Workers Compensation - California - Phoenix, AZ

PMA CompaniesPhoenix, AZ, United States
A tiempo completo

Back Claims Representative - Workers Compensation - California #4748 Multiple Locations Apply X Facebook LinkedIn Email Copy Job Description:As a member of our Claims team, utilize your knowledge o... Mostrar más

 • Oferta promocionada

Senior Complex Liability Claim Specialist

Arizona StaffingPhoenix, AZ, United States
A tiempo completo

Complex Liability Claim SpecialistZurich North America is seeking an experienced Claims Specialist to join our Complex Liability Claims team.This role involves managing complex primary high-exposur... Mostrar más

 • Oferta promocionada

P&C Claims Industry Expert (Industry Advisor)

ClifyXPhoenix, AZ, United States
A tiempo completo

P&C Claims Industry Expert Must Have Technical/Functional Skills.Personal Lines Claims, claims transformation, claims technology, or equivalent combination.Demonstrated success leading cross-functi... Mostrar más

 • Oferta promocionada

Senior Claim Specialist

Pyramid ConsultingScottsdale, AZ, United States
A tiempo completo

Senior Claim SpecialistImmediate need for a talented Senior Claim Specialist with experience in the Insurance Industry.This is a 06Months Contract opportunity with long-term potential and is locate... Mostrar más

 • Oferta promocionada

Claims Consultant

The MJ CompaniesPhoenix, AZ, United States
A tiempo completo

We are The MJ Companiesa firm dedicated to inspiring the success, fulfillment, and wellbeing of each person we serve.Our commitment to excellence and collaboration has enabled us to maintain a best... Mostrar más

 • Oferta promocionada

Claim Representative - Liability

SedgwickPhoenix, AZ, United States
A tiempo completo

By joining Sedgwick, you'll be part of something truly meaningful.It's what our 33,000 colleagues do every day for people around the world who are facing the unexpected.We invite you to grow your c... Mostrar más

 • Oferta promocionada

Complex Claims Director, Excess

AIG - American International Group, Inc.Scottsdale, AZ, United States
A tiempo completo

At AIG, we are reimagining the way we help customers to manage risk.Join us as a Complex Director in Excess Claims to play your part in that transformation.Its an opportunity to grow your skills an... Mostrar más

 • Oferta promocionada

Service Sales Representative - AZ, NV & NM

BeaconMedaesPhoenix, AZ, United States
A tiempo completo

Your role as Service Sales RepresentativeBeaconMedaes is seeking a Service Sales Representative to support and strengthen customer relationships in the Arizona, Nevada and New Mexico area.This role... Mostrar más

 • Oferta promocionada

Senior Examiner

W. R. BerkleyScottsdale, AZ, United States
A tiempo completo

Senior Claims ExaminerNautilus Insurance is seeking a Senior Claims Examiner to join their team.This role can be located in their Scottsdale, AZ office, or remotely for a highly qualified candidate... Mostrar más

 • Oferta promocionada

Casualty Claims Specialist

First Chicago Insurance CompanyPhoenix, AZ, United States
A tiempo completo

At First Chicago Insurance Company, our employees are our biggest asset! It is our mission to attract and retain intelligent, motivated, ethical employees who strive for excellence and growth, and ... Mostrar más

 • Oferta promocionada

Remote Healthcare CSR $16 / hr. - Irving TX ONLY

RemXPhoenix, AZ, United States
Teletrabajo
A tiempo completo

RemX will never ask for any form of payment prior to or throughout the hiring process.If you have been asked for payment of any kind, please notify us right away.This is illegitimate and unlawful.R... Mostrar más

 • Oferta promocionada

Claims Representative - Workers Compensation

SynecticsPhoenix, AZ, United States
A tiempo completo

Description :To process low level workers compensation claims to determine benefits due; to ensure ongoing adjudication of claims within company standards and industry best practices; and to identi... Mostrar más

 • Oferta promocionada

Claims Associate

Falvey Insurance GroupPhoenix, AZ, United States
A tiempo completo

About Falvey Insurance GroupA Culture of CollaborationFalvey's culture is grounded in collaboration and connection.We intentionally bring perspectives together, knowing that strong teamwork leads t... Mostrar más

 • Oferta promocionada

Claims - Field Claims Representative

The Cincinnati Insurance CompaniesPhoenix, AZ, United States
A tiempo completo

Make a difference with a career in insurance.At The Cincinnati Insurance Companies, we put people first and apply the Golden Rule to our daily operations.To put this into action, were looking for e... Mostrar más

 • Oferta promocionada

REMOTE Claims Representative - Workers Compensation - (LC2025)

Techlink SystemsPhoenix, AZ, United States
Teletrabajo
Indefinido

Job DescriptionJob DescriptionJob Title : Claims Representative - Workers CompensationLocation (On-site, Remote, or Hybrid?) :Phoenix, AZ (remote)Contract Duration :Contract until 12 / 26 / 2025Des... Mostrar más

 • Oferta promocionada

Sr Workers Compensation Claims Representative (Remote) - Scottsdale, AZ (85250)

WR BerkleyScottsdale, AZ, United States
Teletrabajo
A tiempo completo

Company Details BerkleyNet is an innovative workers compensation insurance provider that does all of our business online.Our Goal? To make doing business Ridiculously Fast.Responsibilities As a Sen... Mostrar más

 • Oferta promocionada

Blue Star - Claims Assistant

Transtar Insurance Brokers IncPhoenix, AZ, United States
A tiempo completo

Claims Assistant Job DescriptionBlue Star Claims LLC is a Third-Party Administrator specializing in Occupational Accident claims and Trucking Physical Damage and Cargo claims throughout the United ... Mostrar más

 • Oferta promocionada

Manager, Claims

AmTrust FinancialScottsdale, AZ, United States
A tiempo completo

Workers' Compensation Claims ManagerAmTrust Financial Services, a fast growing commercial insurance company, has an immediate need for a Workers' Compensation Claims Manager.The Workers Compensatio... Mostrar más

 • Oferta promocionada

Claims Representative - Workers Compensation

Cynet SystemsPhoenix, AZ, United States
A tiempo completo

Job Description:The Claims Representative - Workers Compensation is responsible for processing low-level workers compensation claims, determining compensability and benefits due, and managing claim... Mostrar más

 • Oferta promocionada

Claims Examiner 3

Swift TransportationPhoenix, AZ, United States
A tiempo completo

Swift Transportation Job PostPosition at Swift TransportationWho We Are: Swift Transportation has been an industry leader for many years with a profound history dating back to the 1960s.Swift is th... Mostrar más