Claims Representative - Workers Compensation

• 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 agency.
• 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 plan pursuant to the claim or client contract.
• Administers subrogation of claims and negotiates settlements.
• Communicates claim action with claimant and 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.

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

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

• Two (2) years of claims management experience or equivalent combination of education and experience or successful completion of Claims Representative training required.

• Developing knowledge of regulations, offsets and deductions, disability duration, medical management practices and Social Security and Medicare application procedure as applicable to line of business.
• Excellent oral and written communication, 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.

Nesco Resource