WC Claims Representative - Charlotte, NC (Hybrid)
About The Position
Selective Insurance is seeking a Workers Comp Claim Rep who will be hanlding claims for the Heartland Region (IA, IN, IL, KS, MI, MN, MO, WI). Responsibility includes effective and timely communication with employer, employee, and medical provider. Investigate lost time claims to determine coverage and compensability based on jurisdictional guidelines. Obtain relevant information necessary for a thorough investigation. Freeze facts of claims and make timely decisions. Effective and consistent partnership with nurse management to return injured worker back to gainful employment when necessary. Manage administration of benefits and claim resolution. Provide compelling customer service. All job duties and responsibilities must be carried out in compliance with applicable legal and regulatory requirements.
Requirements
- Knowledge of workers compensation statutes, coverage, and case law.
- Excellent written and verbal communication skills.
- Working knowledge of medical treatment and terms as related to medical only workers compensation claims.
- Critical thinking skills to assess compensability of WC claim as it relates to the facts and law.
Nice To Haves
- College degree preferred.
- 1-3 years of claims experience preferred.
- Experience handling claims in IA, IN, IL, KS, MI, MN, MO, WI.
Responsibilities
- Receives assigned lost time claims for investigation to determine coverage and compensability on claims with a short disability period of 8 weeks or less (could occasionally exceed 8 weeks).
- Processes claims which include the following activities: Making contacts, setting reserves, establishing file in MCS, evaluating exposure, and establishing initial and subsequent reserves on less severe claims with a general exposure of less than $75,000, and analyzing investigational data. Makes timely payments and follow through to resolution. May occasionally handle claims that exceed $75,000.
- Documents claim files and maintains control of work through documentation or diary system.
- Handle non-litigated and litigated claims.
- File state forms timely in accordance with statutory guidelines.
- Collaborate with nurses and vendors on medical and disability management.
- Prepare for and participate in claims review and settlement conferences.
- Ensures compliance with company, state, and federal regulations.
Benefits
- Comprehensive health care plans
- Retirement savings plan with company match
- Discounted Employee Stock Purchase Program
- Tuition assistance and reimbursement programs
- 20 days of paid time off
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
Associate degree
