Description

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  Claims Management: Investigate, evaluate, and manage workers' compensation claims from inception to resolution, ensuring compliance with applicable laws, regulations, and company policies. As a Senior Claim Representative, candidate will be responsible for more complex and intricate, requiring an advanced skillset.
  
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  Communication: Serve as the primary point of contact for injured workers, employers, medical providers, and other stakeholders, providing clear and professional communication throughout the claims process.
  
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  Investigation: Conduct thorough investigations of claims, including gathering statements, reviewing medical records, and analyzing accident reports to determine compensability and liability.
  
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  Decision-Making: Make timely and accurate decisions regarding claim acceptance, denial, or settlement based on the facts of the case and applicable laws.
  
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  Documentation: Maintain detailed and organized claim files, documenting all activities, communications, and decisions in the claims management system.
  
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  Cost Control: Monitor and manage claim costs, including medical expenses, indemnity payments, and legal fees, while ensuring appropriate reserves are established and maintained.
  
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  Compliance: Ensure adherence to state-specific workers' compensation laws, regulations, and reporting requirements.
  
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  Customer Service: Provide exceptional service to clients by addressing inquiries, resolving issues, and delivering timely updates on claim status.
  
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  Collaboration: Work closely with internal teams, including legal, medical, and risk management professionals, to achieve optimal claim outcomes.