Claims Representative-Workers Compensation

Sentry Insurance•Richmond, VA

1d•Hybrid

About The Position

Drive successful WC claim outcomes through smart investigation, clear communication, and proactive management of treatment and return to work. This role will be staffed in our Richmond, VA office following the hybrid work model. This role is NOT available for remote work. Based on experience and qualifications, the pay range for this position is $68,100-$102,100 annually.

Requirements

Obtain and maintain state adjuster licensing as applicable
Bachelors Degree or equivalent work experience
Minimum 1 year of related work experience
Ability to review and analyze detailed documents, insurance policies, coverages, medical terminology, and insurance regulations
Confidence when making appropriate claim decisions, prioritizing, and managing workload
Effective verbal and written communication skills

Nice To Haves

Insurance experience and/or coursework preferred

Responsibilities

Provide all aspects of customer service with empathy and understanding by assisting customers through difficult situations.
Act as the primary point of contact between the injured employee, health care providers and employers.
Maintain active communication with all parties involved to gather information and provide updates on the status of claims.
Verify coverage, compensability and investigate causation by gathering pertinent information.
Conduct thorough investigations into the circumstances surrounding the injury or illness. This may involve reviewing medical records, interviewing involved parties, and examining workplace conditions including job descriptions.
Assess the extent of the employee’s injury or illness to determine the benefits they are entitled to receive under workers’ compensation (WC) laws. This may include medical treatment and disability payments.
Effectively manage and develop action plans to move files toward resolution.
Calculate benefits, evaluate, and approve payments to medical providers, suppliers, and the injured employee.
Collaborate with employers, health care professionals and case managers to facilitate the injured employee’s return to work in a safe and timely manner, which may involve modified duty assignments or accommodation.
Accurately document all aspects of the claim, including investigation details, injury reports, medical records and correspondence with any involved parties.
Ensure compliance with regulations governing WC claims, including reporting requirements, deadlines, and file coding as defined by the state.
Collaborate with the special investigation unit, as necessary to investigate and mitigate fraud.
Perform other job-related duties as assigned from time to time.

Benefits

Scheduled Hybrid work model
In-office workspace and materials for home office
Equipment for home office
Meal Subsidy
401(K) plan with a dollar for dollar match on your first eight percent, plus immediate vesting
Sentry University (SentryU)
Tuition Reimbursement program
Generous Paid-Time Off plan
Volunteer-Time off
Group Medical, Dental, Vision, Life insurance
Parental leave
Health and Wellness benefits
Well-being and Employee Assistance programs
Sentry Foundation gift matching program