Workers Compensation Claims Specialist
7 days ago
Workers Compensation Claims Specialist
About the Role:We are seeking a highly skilled Workers Compensation Claims Specialist to join our team. As a Plant-Based Workers Compensation Claims Handler, you will be responsible for handling complex claims with excellent customer service, quality claims handling, and loss cost management.
This is a full-time position with a hybrid work schedule to be considered once fully trained.
The ideal candidate will have 3-5 years of Illinois Workers' Compensation claims management experience and a college degree or equivalent combination of education and experience.
Responsibilities:- Analyze and process complex workers compensation claims by investigating and gathering information to determine exposure on the claim.
- Handle a full case load with proven ability to handle cases of increased severity.
- Manage claims through well-developed action plans to ensure timely and cost-effective resolutions.
- Calculate and assign timely and appropriate reserves to claims; manages reserve adequacy throughout the life of the claim.
- Calculate and pay benefits due; approve and make timely claim payments and adjustments; and settle claims within designated authority level.
- Prepare necessary state fillings within statutory limits.
- Coordinate vendor referrals for additional investigation and/or litigation management.
- Use appropriate cost containment techniques including strategic vendor partnerships to reduce overall cost of claims.
- Manage claim recoveries, including but not limited to: subrogation, Second Injury Fund excess recoveries and Social Security and Medicare offsets.
- Report claims to the excess carrier.
- Communicate claim activity and processing with the claimant and the client.
- Ensure claim files are properly documented, and claims coding is correct.
- 3-5 years of Illinois Workers' Compensation claims management experience.
- College degree and 3-5 years of Illinois claims management experience or equivalent combination of education and experience preferred.
- High school diploma and 3-5 years related Illinois claims experience accepted.
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