W.C. Claims Representative

Acuity Insurance•Sheboygan, WI

10d•$75,000 - $90,000•Onsite

About The Position

Acuity is seeking a Workers' Compensation Claims Representative to investigate, evaluate, direct, and control Workers’ Compensation claims from multiple jurisdictions. In this role, you will provide superior customer service to our policyholders and agents.

Requirements

Thorough understanding of personal computing, typing skills, technology and use of mobile devices.
Basic understanding of medical terminology and treatment, physiology, and anatomy.
Understanding of WC statutes and case law.
Excellent written and verbal communication skills.
Ability and willingness to provide quality customer service.
Must be a self-starter, take on and create new opportunities.
Ability to work both independently and in collaboration with others.
Proven organizational and time management skills.

Nice To Haves

College degree preferred.
Minimum 2-3 years of experience in handling Workers’ Compensation claims preferred.
Someone who has demonstrated sustained excellence over a prolonged period of time.
Independently conducts claim reviews & service presentations to agents and potential new insureds.
Independently handles litigated claims including attending prehearings, mediations, and hearings.
Has served as a mentor for a new employee or willingness to do so by volunteering with job shadowing and training activities.
Participates in or conducts a training session for unit and/or department.
Has accompanied SIU on field claim investigations.

Responsibilities

Understands and consistently applies customer service concepts and requirements.
Conducts thorough initial investigations to determine coverage, compensability, subrogation, and fraud.
Understands basic anatomy and medical terminology. Able to read and evaluate medical reports to determine extent of injury and treatment plans. Able to recognize, research, and analyze complex medical issues.
Implements pro-active direction and control with timely intervention and action planning.
Understands basic reserving concepts and adheres to company reserving guidelines.
Effectively utilizes managed care cost containment programs, services, and vendors. Consistently provides direction to assure control of costs.
Recognizes and aggressively pursues all potential subrogation recovery opportunities.
Understands and consistently applies legal and statutory concepts of the applicable jurisdiction.
Provides consistent meaningful file documentation with effective use of the queue and calendar system.
Demonstrates superior communication skills in all aspects of the position. Places emphasis on meaningful correspondence and effective customer service interactions.
Conducts Claim Reviews independently with Insureds and Agents.
Demonstrate interest and ability to handle increasingly more complex issues.
Maintain a positive attitude and exhibit consistent professionalism.
Demonstrate creativity and independently conduct research.
Regular and predictable attendance.
Performs other duties as assigned.