Claims Representative (Workers' Compensation)

Dollar General Corporation•Goodlettsville, TN

32d•Remote

About The Position

General Summary: Investigate, evaluate, negotiate, and resolve workers' compensation claims with minimal supervision. Duties & Responsibilities: Conduct interviews with injured employees, store personnel and medical care providers within 24 hours of receiving reported incident. Utilize complex problem solving, critical thinking skills and strong organization skills to timely evaluate compensability and management of claim assignments. Maintain communication with appropriate parties throughout life of file for proper medical and disability management and resolution. Utilize professional experience and investigative skills to evaluate monetary exposure of claim and ability to establish action plan to include medical, disability management and resolution. Proactively and timely coordinate and communicate with doctor, injured employee and store personnel for light duty or full duty return to work, payment of appropriate benefits, and properly utilize in-house and field nurse resources for medical and disability management. Ability to timely evaluate requests for medical care regarding causation and relatedness and in compliance with state requirements. Timely evaluate and pay medical and indemnity benefits in accordance with the law. Complete appropriate state reporting. Coordinate and communicate with service providers such as defense attorneys, medical case managers and private investigators to minimize claim expense and maximize results. Develop and maintain a proactive strategic plan of action for the life of the file and resolve claims and make recommendations for claim resolution efficiently and within best practice expectations, and state requirements. Maintain a working knowledge of multiple state workers' compensation laws and statutes and maintain appropriate state required licensing.

Requirements

Extensive claim handling experience with emphasis on workers' compensation.
Possess complex problem solving and strong decision-making skills.
Strong organizational skills and the ability to prioritize.
Customer service oriented and works well in a team environment.
Excellent written and verbal communication skills.
Must be detail oriented and able to meet deadlines.
Ability to handle confrontational situations in a mature and professional manner.
Working knowledge of medical and legal terminology.
Working knowledge of Microsoft Office programs
1-2 years of experience handling/processing Workers Compensation claims is REQUIRED.

Responsibilities

Conduct interviews with injured employees, store personnel and medical care providers within 24 hours of receiving reported incident.
Utilize complex problem solving, critical thinking skills and strong organization skills to timely evaluate compensability and management of claim assignments.
Maintain communication with appropriate parties throughout life of file for proper medical and disability management and resolution.
Utilize professional experience and investigative skills to evaluate monetary exposure of claim and ability to establish action plan to include medical, disability management and resolution.
Proactively and timely coordinate and communicate with doctor, injured employee and store personnel for light duty or full duty return to work, payment of appropriate benefits, and properly utilize in-house and field nurse resources for medical and disability management.
Ability to timely evaluate requests for medical care regarding causation and relatedness and in compliance with state requirements.
Timely evaluate and pay medical and indemnity benefits in accordance with the law.
Complete appropriate state reporting.
Coordinate and communicate with service providers such as defense attorneys, medical case managers and private investigators to minimize claim expense and maximize results.
Develop and maintain a proactive strategic plan of action for the life of the file and resolve claims and make recommendations for claim resolution efficiently and within best practice expectations, and state requirements.
Maintain a working knowledge of multiple state workers' compensation laws and statutes and maintain appropriate state required licensing.