Senior Workers Comp Claims Representative

Your Senior Workers Compensation Claims Representative Skills are Needed!

The Qualifications of the Senior Workers Compensation Claims Representative are as follows:

Education
Bachelor’s degree in Business Administration, Healthcare Administration or related field OR the equivalent in relevant coursework and related experience required.

Experience
Five years previous experience reviewing, investigating, and closing indemnity workers’ compensation claims, including working with attorneys, rehabilitation and medical vendors, and corporate clients.
Thorough working knowledge of workers’ compensation statutes and workers’ compensation filing procedures.

Skills/Abilities
Proficient in Microsoft Windows.
Demonstrated knowledge of medical terminology.
Effective oral and written communication skills and customer service skills are essential.
Strong interpersonal and negotiation skills and decision-making ability.
Attention to detail and analytical skills required.
Must be able to meet strict deadlines with a high level of accuracy.
Must be able to work independently as well as within a team.
REQUIREMENTS
Responsible for taking a team leadership role by mentoring less experienced claim representatives while being able to handle own claims with very little supervision in verifying workers’ compensation coverage of employer and injured employee against appropriate sources, investigating compensability and the medical causal relationship to ensure proper payment of eligible claims. In addition, responsible for negotiating workers’ compensation cases up to $100,000 and computing medical bills associated with accidents. Represents company at administrative hearings or conferences with state regulatory agencies and/or conferences with defense attorneys. Responsible for managing assigned accounts.

The Responsibilities of the Senior Workers Compensation Claims Representative are as follows:
Verifies workers’ compensation coverage of employer and injured employee from policy information, underwriting, etc. and documents the state the employer is domiciled in for both Illinois and Indiana.
Responsible for customer satisfaction of assigned accounts within region when written premium surpasses $100,000. Responsible for all but minor medical only claims for these accounts, including communication of reserves and other issues with the account.
Investigates compensability to determine whether if employee injury is compensable under workers’ compensation via review of First Report of Injury, contact with employer, employee and corporate and insurance risk management personnel.
Investigates, analyzes and determines the medical causal relationship between employee injury and the accident or activity to ensure the proper payment of claims. Determination is based on information obtained through contact with the employer and employee and/or medical provider, review of medical reports and clarification of medical treatment or medical charges with the provider as they relate to the injury.
Negotiates settlements to workers’ compensation cases, up to $100,000.00, with attorneys, clients or employees.
Collaborates with rehabilitation or medical vendors to expedite an early return to work for the injured employee.
Represents company at pre-hearings and administrative hearings and conferences with state regulatory agencies. In addition, works with defense attorneys in preparing cases for litigation.
Computes the proper payment for the medical bills and the proper wage replacement benefits for the workers’ compensation indemnity claims directly associated with the accident or activity, ensuring that all payments are made in an accurate and timely manner in compliance with state legislation and internal performance standards.
Investigates workers’ compensation cases to determine possibility of partial or complete subrogation through second injury fund. Presents recommendation to Manager, Claims for review and referral.
Establishes and maintains effective working relationship with rehabilitation and medical vendors and with corporate customers/clients.
Stays abreast of changes in workers’ compensation statutes, case law and rehabilitation efforts/advancements in order to accurately interpret and apply relevant laws.
Adheres to the Employee Code of Ethical Conduct and completes additional responsibilities as requested.

If you fit these specifications, then you are the candidate Best Headhunters is searching for.

Our client offers a competitive salary plus commission based on performance. For additional information, visit our web site at www.bestheadhunters.com or www.bestinsurancejobs.com

Best Headhunters is an executive search firm. Our clients pay all fees related to the search. There is never a fee to the job seeker. We offer complete career coaching with job seekers that are qualified and match the job description and work with you every step of the way to give you the tools you will need to advance your career and increase your value in the workplace. You get instant client feedback, and we will negotiate the best salary and incentive package for you.

Today nothing is permanent. We live in an uncertain job environment with many mergers and downsizing taking place, so you must be pro active!

Keywords: Senior Claims Representative, workers compensation