Workers' Compensation Claims Specialist III

4 weeks ago

Des Moines, United States Creative Risk Solutions Full time

Workers' Compensation Claims Specialist III - East

Do you have a minimum of 5 years claim handling experience? Do you provide excellent customer service and enjoy building lasting relationships with clients? The person in this position will service self-insured accounts and will telecommute for this role. Qualified candidates will need to have jurisdictional experience in one or more of the following states: FL, KY, SC, VA, NJ, RI, MA, NC, TN, and GA. Duties: Receives, gathers and accurately transmits workers’ compensation information to the company, from communications with the insured, claimants, and internal staff in a timely manner. Investigates, evaluates, and resolves lost time workers’ compensation claims, including litigated claims. Mediates situations as they arise between the insured and the insurance company, to include researching coverage issues. Enters and maintains accurate information on a computer system during the claim process, to include final settlement information. Generates checks for indemnity and medical payments daily. Compiles and interprets workers’ compensation reports on designated accounts, as requested. Participates in claim reviews and attending risk control workshops when requested by agency partners or insureds. These could be in person or by phone. Ability to adjudicate lost time claims in multiple jurisdictions. Develops and monitors consistency in procedural matters of claims handling process within CRS. Willingness to become licensed if required in jurisdiction where claims are handled. Knowledge, Skills, and Abilities: Knowledge of workers’ compensation insurance coverage and the ability to apply that knowledge in the performance of the job duties. Skillful knowledge of claims processing procedures. Ability to work with persons under adverse or highly emotional conditions. Knowledge of organizational methods and the ability to manage multiple tasks/duties simultaneously. Ability to work daily and extended hours, as necessary. Ability to maintain confidentiality. Ability to act in a professional and courteous manner. Ability to learn various software programs. Must be knowledgeable of and comply with our Client Privacy Policy, HIPAA regulations and E&O procedures and policies. Qualifications: Education:High School education with college preferred. Experience:Minimum of five years claims experience with strong background in workers’ compensation claims handling. Jurisdictional expertise and required licensing as needed in one or more of the following states: FL, KY, SC, VA, NJ, RI, MA, NC, TN, and GA. Benefits: In addition to core benefits like health, dental and vision, also enjoy benefits such as: Paid parental leave and supportive new parent benefits — we know being a working parent is hard, and we want to support our employees in this journey Company paid continuing education & tuition reimbursement — we support those who want to develop and grow. 401k Profit Sharing — each year, we make a lump sum contribution to every full-time employee’s 401k. This means, even if you’re not in a position to set money aside for the future at any point in time, we will do it on your behalf We are forward-thinking and want to be sure your future is cared for. Generous time off practices in addition to paid holidays — Yes, we actually encourage employees to use their time off, and they do. After all, you can’t be at your best for our clients if you’re not at your best for yourself first. Supportive of community efforts with paid volunteer time off and employee matching gifts to charities that are important to you — Through ourfoundation,we offer several vehicles where you can make an impact and care for those around you. DE&I programs —we are committed to celebrating every employee’s unique diversity, equity, and inclusion (DE&I) experience with us. Not only do we offer all employees a paid diversity day time off option, but we also have a Chief Diversity Officer on hand, as well as a DE&I project team, committee, and interest group. You will have the opportunity to take part in those if you wish Consistent merit increase and promotion opportunities — Annually, employees are reviewed for merit increases and promotion opportunities because we believe growth is important — not only with your financial wellbeing, but also your career wellbeing. Discretionary bonus opportunity — Yes, there is an annual opportunity to make more money. Who doesn’t love that?

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