Claims representative • rio rancho nm
Manage an average caseload of approximately 130 workers' compensation files, including highly complex claims.Initiate and conduct timely investigations, and determine compensability based on state ... Show more
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Leads and manages team responsible for operations activities including claims processing, benefit interpretation, provider services, provider enrollment, etc.Oversees performance and financial resu... Show more
The average salary range is between $ 34,117 and $ 67,474 year , with the average salary hovering around $ 41,644 year .
What you will be doing:
Manage an average caseload of approximately 130 workers' compensation files, including highly complex claims
Initiate and conduct timely investigations, and determine compensability based on state law and established guidelines
Develop and execute well-structured action plans that drive each claim to an appropriate and timely resolution
Manage medical treatment and medical billing, authorizing care as appropriate
Calculate and issue benefit payments, and approve all claim payments within designated authority
Compute and set reserves within company guidelines
Refer files to outside defense counsel and direct litigation strategy
Pursue claim recoveries of all types, including deductible and subrogation
Maintain a disciplined diary system, document file activity, and conduct file reviews independently
Communicate proactively with clients on claim status, injury trends, and safety-related concerns
What you must have:
Five (5) or more years of workers' compensation claims experience, or an equivalent combination of education and experience
Bachelor's degree in a related field (preferred)
Technical command of statutory regulations and medical terminology
Proven ability to independently manage very complex indemnity claims
Excellent written and verbal communication skills, including the ability to translate technical detail for claimants, clients, and internal staff
Strong analytical skills and sound, defensible decision-making
Any certifications or licenses required by state regulation
Proficiency in Word and Excel (preferred)
Self-insured claims handling experience (preferred)
City, county, and/or district (public entity) claims experience (preferred)
Other Information:
Why This Role
Senior-level autonomy with real settlement and reserve authority
Established national platform with defined career progression
Direct reporting line to a Claims Supervisor — flat, accessible structure
Full benefits package
If you are a serious claims professional looking to level up in your career, submit your resume now to be considered !
Salary/Rate Range: $88,000 - $90,000
Thank you for your interest in this opportunity. If you are selected to move forward in the process, we will contact you directly. If you do not hear from us, we encourage you to continue visiting our website for other roles that may be a good fit.
