Triage Claims Associate
About The Position
The Triage Claims Associate for Workers’ Compensation plays a critical role in the initial assessment and routing of a claim. This position is responsible for reviewing incoming claims to determine the severity and urgency, as well as follow up actions needed by gathering all necessary information and initiating the 3-points of contact during the first 10 days in the life of assigned claims. This role ensures claims files are accurate and complete prior to their transfer to the indemnity claims team. A key objective of this role is to equip the Associate with the knowledge, skills, and abilities necessary to effectively manage a caseload of 70+ files and successfully complete either the SIP exam or earn the Claims Examiner designation within one year of hire for California. Additional Workers’ Compensation licensing may be required for other jurisdictions, as applicable.
Requirements
- High school diploma or equivalent required.
- Minimum 1+ year of related office or customer service experience.
- Adept at computer use including proficiency with on-line databases and/or claims management software (CXP or related) and Microsoft Office Suite.
- Ability to work in a fast-paced, detail-oriented environment.
- Strong analytical skills and demonstrated attention to detail.
- Must have good time management skills and follow through on deliverables.
- Collaborative with a team orientation and works with a sense of urgency for execution of deliverables.
Nice To Haves
- Associate or Bachelor’s degree preferred.
- Prior Workers’ Compensation industry experience highly preferred.
- Basic understanding of workers compensation terminology and claims processes (preferred).
Responsibilities
- Reviews and analyzes incoming workers' compensation claims to determine the severity of the claims, benefits owed, ensures medical treatment is communicated to the injured worker, and reviews the claims file for completeness and accuracy of details.
- Communicates with injured workers, employers, medical providers, and internal teams to gather initial information.
- Documents claim details and triage decisions in the claims management system.
- Identifies potential fraud indicators and escalates as needed.
- Maintains compliance with company policies and state regulatory requirements.
- Supports continuous improvement initiatives within the triage process.
Benefits
- Competitive benefits package
- Generous medical, dental, and vision plans
- 401K retirement plans and company match
- Bonus potential for all positions
- Paid Time Off
- Paid holidays throughout the calendar year
- Support for continued learning
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What This Job Offers
Job Type
Full-time
Career Level
Entry Level
Education Level
High school or GED
