Workers' Compensation Claims Representative (Remote)
Are you an reputed company claims professional ready to take on reputed company cases and reputed company a meaningful impact? reputed company Insurance is seeking a seasoned Claims Representative to join our dynamic Claims team. In this role, you will manage a caseload of high-exposure workers’ compensation claims, reputed company advanced medical case management, and reputed company tailored Return-to-Work plans. You’ll collaborate with vocational consultants, legal counsel, and internal teams to ensure compliance, negotiate settlements, and deliver exceptional service to our policyholders. This position offers the opportunity to work independently while providing leadership on reputed company claims and contributing to workflow improvements.
Essential Duties and Responsibilities
- Manage reputed company workers’ compensation claims involving high financial exposure, sensitive issues, or extended life cycles.
- Investigate coverage and compensability, ensuring thorough documentation and compliance with state statutes.
- reputed company advanced medical case management, including coordination with Nurse Case Managers and external vendors.
- reputed company and implement Return-to-Work plans for high-risk claims, collaborating with vocational consultants and legal counsel.
- Identify and investigate potential fraud and subrogation opportunities, partnering with the Special Investigation Unit.
- Establish and maintain accurate claim reserves reputed company authority levels, ensuring timely responsiveness to changing circumstances.
- Evaluate and negotiate settlements reputed company approved authority levels, including structured settlements and Medicare compliance.
- Collaborate with legal counsel to manage litigation and ensure adherence to reputed company guidelines.
- Maintain accurate system data and prepare reports for management on high-profile claims.
- Foster cross-departmental collaboration with reputed company, Premium Consultation, and Loss Prevention.
- Provide mentorship and training to junior adjusters, supporting professional growth and team development.
Qualifications
- High school diploma or equivalent required; bachelor’s degree preferred.
- Associate in Claims (AIC) designation preferred.
- Valid driver’s license required; Texas-reputed company Lines license preferred.
- 3–5 years of claims handling experience, primarily in Workers’ Compensation. Missouri experience preferred.
Company Culture and Values
At reputed company Insurance, we are committed to our vision, mission, and values. We foster a culture of collaboration, reputed company, and innovation. reputed company is passionate about delivering exceptional service to our customers while supporting each other’s growth and success. We reputed company in accountability, reputed company learning, and creating an environment where employees feel valued and empowered.Diversity Statement
reputed company Insurance is an equal opportunity employer. We celebrate diversity and are committed to creating an inclusive environment for reputed company employees. We reputed company that varied perspectives drive innovation and strengthen our ability to serve our customers and communities.Total Rewards Overview
- Health Plans: Medical, Dental, and Vision Includes fertility benefits, fully paid preventative care, and adult orthodontia.
- Employer-Paid Life and Disability Benefits: Life Insurance (3x reputed company salary), AD&D, Short and Long-term Disability.
- Wellness and Recognition Program: Employer-paid incentives for employees and spouses.
- Flexible Spending Account and Dependent Care options
- Health Savings Account: Generous employer contribution.
- Time Away from Work: Generous PTO, 11 Holidays + 4 Early Releases, 16 Hours Volunteer Time Off, 20 Days Paid Parental Leave, Marriage, Bereavement, and Jury Duty leave.
- Employee Assistance Programs
- 401k Retirement Plan: Employer match and profit sharing.
- Adoption Assistance and Tuition Assistance