Sr. Workers Compensation Claims Representative

Senior Claims Representative

As a Senior Claims Representative, you will be responsible for the investigation, evaluation, mitigation and resolution of an inventory of lost time and catastrophic workers' compensation injury claims in multiple jurisdictions.

Responsibilities include :

• Investigate workers' compensation claims by interviewing injured workers, witnesses, and policyholders to verify coverage and determine compensability and benefits due
• Calculate and set timely financial reserves and proactively manage reserve adequacy throughout claim lifecycle
• Record and code injured worker demographics, job information and accident information in company's claims management system and files necessary forms with state regulatory agencies
• Issue timely payments to injured workers, medical providers and service vendors
• Coordinate and actively manage medical treatment of injured workers to ensure timely rehabilitation
• Negotiate settlements of claims within designated authority with injured workers and attorneys
• Serve as the team's subject matter expert of the Workers' Compensation Act, adjudication process, and regulatory compliance framework in assigned jurisdictions
• Identify and manage subrogation, Second Injury Fund and joint coverage recovery opportunities
• Regularly communicate claim activity and status updates to policyholders, injured workers and other interested parties in a professional, thoughtful and tactful manner
• Notify management and develop reports for large exposure claims and comply with reinsurance reporting requirements
• Manage the claims litigation process to ensure timely and cost-effective claims resolution
• Monitor the expenses and effectiveness of managed care and investigation vendors
• Periodically travel to attend hearings, conferences and training sessions
• Attend and participate in claim file reviews with management and defense attorneys
• Coordinate and lead special projects or processes as assigned by management
• Assists with oversight and supervisory duties when the team supervisor is unavailable or as assigned by supervisor
• Support management with training and staff development
• Support management with vendor management activities
• Continuously strives to improve our product and business results through innovation
• Obtain and maintain adjuster license(s) in assigned jurisdictions

Qualifications include :

Additional Company Details :

The company is an equal employment opportunity employer. For a qualified candidate with jurisdiction experience with workers compensation claims in California (CA), Arizona (AZ), Nevada (NV), Colorado (CO), Nebraska (NE), Oklahoma (OK), or Utah (UT), the team will consider remote candidates. We do not accept any unsolicited resumes from external recruiting firms. The company offers a competitive compensation plan and robust benefits package for full time regular employees. Base salary & Benefits include Health, dental, vision, life, disability, wellness, paid time off, 401(k) and profit-sharing plans. Base Salary Range : 65k - 95k The actual salary for this position will be determined by a number of factors, including the scope, complexity and location of the role; the skills, education, training, credentials and experience of the candidate; and other conditions of employment.

Additional Requirements :

Travel Requirements Low level of domestic U.S. travel required (up to 5% - 10% of time)