Claims Representative

LWCC People Operations•Baton Rouge, LA

About The Position

LWCC is a private mutual workers’ compensation company dedicated to excellence in execution, from underwriting to compassionate care of injured workers. Its purpose is to help Louisiana thrive by bettering the state one business and one worker at a time. LWCC has been recognized by industry leaders and named to Ward’s 50® group of top-performing insurance companies. The Claims Representative investigates, evaluates, and handles assigned claims through final disposition in accordance with company procedures. The role investigates coverage and compensability issues and handles lost-time claims, including medical case management, litigation management, return to work, and settlement when necessary. It uses technology and systems for claims management, including document management, utilization review, and pharmacy management, and develops the skills needed to proactively manage a caseload, make decisions, manage time, and handle difficult conversations. The role requires ongoing communication with injured workers, policyholders, agents, medical providers, and attorneys; effective service to agents and policyholders; and compliance with customer-service standards, claim procedures, productivity objectives, and claim-cost objectives. The representative must continue learning applicable laws, regulations, and medical guidelines and contribute to individual, team, and departmental goals.

Requirements

Bachelor’s degree and at least two years of claims-handling experience; alternatively, a high school diploma or GED and four years of claims-handling experience may be considered, or a high school diploma or GED, CPCU designation, and two years of claims-handling experience may be considered in lieu of a college degree.
Active Louisiana Workers’ Compensation Adjuster License before starting or obtained within seven business days after the start date; the employee must maintain continuing education units and an up-to-date adjuster license.
Computer literacy.
Math skills.
Judgment and problem-solving skills.
Strong communication skills, including empathetic listening, open-mindedness, persuasion, and the ability to handle difficult conversations.
Ability to manage time, make decisions, and proactively manage a caseload.
Trustworthiness, honesty, decisiveness, curiosity, persistence, accountability, willingness to learn, adaptability, and a collaborative approach.
Commitment to customer service and stakeholder experience.
Alignment with the company’s values, mission, and vision.

Nice To Haves

Internal candidates may be considered based on demonstrated performance, including consistently achieving or exceeding established goals, strong time-management and decision-making capabilities, and effective handling of lost-time claims.

Responsibilities

Investigate assigned claims using sound claim-handling techniques in accordance with company claim philosophy and quality-assurance standards.
Investigate and determine coverage, compensability, and subrogation potential on every claim, including second injury fund and longshore 8(f) special fund issues.
Determine proper jurisdiction and classify each claim under state, federal, or maritime class codes.
Establish and adjust reserves, or provide reserve recommendations, consistent with corporate policies and assigned authority levels.
Evaluate and negotiate claim settlements within assigned authority levels.
Manage litigation issues arising under assigned claims, including coverage, compensability, medical causation, and return-to-work issues.
Manage medical case management, utilization review, return to work, pharmacy management, and settlement or mitigation when necessary.
Communicate continuously with injured workers, policyholders, agents, medical providers, plaintiff attorneys, and defense attorneys.
Continue learning applicable laws, regulations, and medical guidelines.
Document claim files with the information necessary to confirm claim issues and provide appropriate service to agents and policyholders.
Comply with customer-service standards and respond promptly to resolve complaints or claim problems.
Manage a personal claim caseload effectively in accordance with productivity and claim-cost objectives.
Take initiative and manage claims in accordance with processes and procedures, supporting individual, team, and departmental goals.
Perform other job duties as needed by the department.