Claims Representative Jobs

About The Position

Requirements

• High school diploma.
• At least one year of customer service experience.
• Experience performing highly independent, complex clerical work involving extensive record keeping.
• Ability to operate a computer keyboard accurately and quickly.
• Experience using multiple software programs and platforms.
• Ability to work under stringent deadlines, prioritize work in a high-volume, multitasking environment, and handle numerous interruptions.
• Ability to deal effectively and professionally with adverse and difficult situations.
• Ability to establish and maintain effective internal and external partnerships.

Nice To Haves

• Prior insurance experience in claims and/or call center experience.

Responsibilities

• Triage incoming calls regarding new and existing workers’ compensation claims.
• Intake new claims and act as a liaison between employees and the Third-Party Administrator (TPA).
• Refer injured workers to treatment facilities and arrange transportation when needed.
• Assist with facilitating post-accident drug testing.
• Support adjusters’ claim investigations by gathering and forwarding information needed to analyze liability and accident root cause.
• Enter claim data into various claims management systems.
• Answer incoming calls from clients, contractors, field office representatives, claims adjusters, attorneys, and physicians.
• Place outgoing calls to claimants, clients, field office representatives, claims adjusters, attorneys, and physicians to follow up on incidents.
• Review and verify Injury Reporting forms before submission to ensure claim information is accurate; obtain additional information or clarification when needed.
• Collect and submit required paperwork to the TPA.
• Assist with the return-to-work process.
• Send acknowledgment letters and post-incident paperwork to appropriate recipients.
• Make effective and appropriate decisions.
• Interpret and communicate policies and procedures, including reading, understanding, and applying complex materials.
• Use proper grammar, spelling, and punctuation in communications and prepare clear, concise documentation in writing and orally.
• Perform clerical tasks and projects as assigned.

Benefits

• Bonuses