Description

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