WC Claims Representative 1

Berkley•Saint Paul, MN

3d•$44,000 - $55,000•Onsite

About The Position

This position is responsible for investigating workers’ compensation injury/illness claims, documenting claim handling, and paying and/or denying benefits in a caseload of primarily medical only (MO) workers’ compensation claims. Limited indemnity (disability) claims may be assigned to representatives for training purposes, at supervisor discretion. This position is also responsible for providing support to the claims department.

Requirements

Minimum of two years office experience or post-high school education.
Ability to interpret and evaluate limited medical and limited legal concepts.
Analysis and decision-making skills.
Good to excellent math and analytical ability.
Good oral and written communication skills.
Willing to learn and apply negotiation techniques.
High school diploma or equivalent

Responsibilities

Investigates claims for compensability by analyzing claims-related information and applying claim handling guidelines.
Verifies active policy/coverage on new claims and determines if claim involves medical benefits only or includes exposure for lost time.
Establishes case reserves consistent with exposure on new claims. Examines reserves on a regular basis and adjusts reserves if there is a significant change in exposure.
Serves and files state forms when required.
Investigates subrogation issues on claims, and places responsible third parties on notice of our client’s subrogation interest. Pursues subrogation or transfers file as appropriate.
Receives and responds to telephone inquiries. This includes but is not limited to contact with injured employees, employers and health care providers.
Authorizes payment of bills for reasonable and necessary medical treatment, expenses associated with claims investigations and obtaining records. Sends bills and records for audit when appropriate.
Authorizes or denies medical benefits within established time frames.
Manages caseload with assistance of computer-operated diary and maintains current diaries.
Participates in on-going training opportunities to remain current on all aspects of claims handling and customer service.
Ensures timely filing of regulatory documents via EDI (Electronic Data Interchange); submits applicable claims to Index Bureau Reporting (ISO) and documents files as applicable.
Provides additional levels of management and claim department operational support to include payment review/approval/input and completes scheduled or special project work as needed.
May perform other functions as assigned.