Job Overview

The primary purpose of this role is to process low-level workers compensation claims to determine benefits due, ensure ongoing adjudication of claims within organizational standards and industry best practices, and identify subrogation of claims and negotiate settlements with general supervision.

Requires two (2) years of claims management experience or an equivalent combination of education and experience, or successful completion of Claims Representative training. Experience in Colorado and Arizona is required.

Essential Functions and Responsibilities

• Processes low-level workers compensation claims determining compensability and benefits due on long-term indemnity claims, monitors reserve accuracy, and files necessary documentation with state agencies.
• Develops and coordinates low-level workers compensation claims' action plans to resolution, return-to-work efforts, and approves claim payments.
• Approves and processes assigned claims, determines benefits due, and administers action plans pursuant to the claim or client contract.
• Administers subrogation of claims and negotiates settlements.
• Communicates claim actions with claimants and the client.
• Ensures claim files are properly documented and claims coding is correct.
• May process low-level lifetime medical and/or defined-period medical claims, which include state and physician filings and decisions on appropriate treatments recommended by utilization review.
• Maintains professional client relationships.

Additional Functions and Responsibilities

Performs other duties as assigned. Supports the organization's quality program(s). Travels as required.

Skills

• Developing knowledge of regulations, offsets and deductions, disability duration, medical management practices, and Social Security and Medicare application procedures as applicable to the line of business.
• Strong verbal and written communication skills, including presentation skills.
• PC literate, including Microsoft Office products.
• Analytical and interpretive skills.
• Strong organizational skills.
• Good interpersonal skills.
• Ability to work in a team environment.
• Ability to meet or exceed Service Expectations.

Education

Bachelor's degree from an accredited college or university preferred.