Workers’ Compensation Claim Representative

5 days ago

Sheboygan, United States ACUITY, A Mutual Insurance Company Full time

Acuity is seeking a Workers’ Compensation Claim Representative to investigate and resolve claims with empathy, passion, and a sense of urgency. Acuity looks to our Workers’ Compensation Claim Representatives to handle the entire claim from the investigation, to the determination of coverage and liability, to disposition including litigation if necessary.

**Internal Deadline to Apply: Thursday, June 13th.**

ESSENTIAL FUNCTIONS:

- Conduct thorough initial investigations to determine coverage, compensability, subrogation, and fraud.
- Understand basic anatomy and medical terminology.
- Read and evaluate medical reports to determine extent of injury and treatment plans. Recognize, research, and analyze complex medical issues.
- Implement pro-active direction and control with timely intervention and action planning.
- Understand basic reserving concepts and adheres to company reserving guidelines.
- Effectively utilize managed care cost containment programs, services, and vendors. Consistently provides direction to assure control of costs.
- Recognize and aggressively pursue all potential subrogation recovery opportunities.
- Provide consistent meaningful file documentation with effective use of the queue and calendar system.
- Demonstrate superior communication skills in all aspects of the position. Place emphasis on meaningful correspondence and effective customer service interactions.
- Conduct Claim Reviews independently with Insureds and Agents.
- Demonstrate interest and ability to handle increasingly more complex issues.
- Regular and predictable attendance.
- Perform other duties as assigned.

EDUCATION:
College degree or equivalent

EXPERIENCE:
Minimum 2-3 years of experience in handling Workers’ Compensation claims preferred

OTHER QUALIFICATIONS:

- 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.
- Someone who has demonstrated sustained excellence over a prolonged period of time.
- Excellent written and verbal communication skills.
- 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.
- 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.
- This position is classified as exempt._

The salary range for this position is $80,000-$120,000 annually. This salary range is an estimate and the actual salary will vary based on applicant’s education, experience, knowledge, skills, and abilities.
- We are an Equal Employment Opportunity employer. Applicants and employees are considered for positions and are evaluated without regard to mental or physical disability, race, color, religion, gender, national origin, age, genetic information, military or veteran status, sexual orientation, marital status or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved._
- We are an Equal Employment Opportunity employer. Applicants and employees are considered for positions and are evaluated without regard to mental or physical disability, race, color, religion, gender, national origin, age, genetic information, military or veteran status, sexual orientation, marital status or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved._

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