Job Title: Workers Compensation Claims Representative
Department: Safety & Loss Control
Reports To: Director of Safety & Loss Control
FLSA Status: Non-exempt
Job Code: Admin II
Summary: Analyzes workers compensation claims and associated reports. Monitors high risk/high value claims and investigates irregularities or concerns regarding the claims. Provide updated status reports on a monthly basis for all Pinnacol and Travelers clients. Provide updated status reports for NAICO claims on a quarterly basis.
Secondary to this role, administer information from clients by phone and email in order to process insurance claims; works with clients, adjusters, and Producers and Account Managers on claims status, problems and questions.
Essential Duties and Responsibilities include the following. Other duties may be assigned.
Monitor and manage monthly workers compensation reports for increases in reserves, medical payments and claim closures.
Knowledge of multiple state workers compensation laws or willingness to research.
Perform database management and input according to department standards.
Handle client and carrier relations and support services for claims
Provide written updates to producers and Director of Safety & Loss Control on a monthly basis regarding anticipated MMI, legal representation or any other unusual activity regarding the claim. Works closely with the Safety Coordinator for clients or claimants that have been released to modified duty and may qualify for transitional duty at not-for-profit organizations.
Analysis of loss runs and loss reserves; prepare written material for and participate in claims reviews
Client and site visits when appropriate. Site visits must be approved by manager.
Must have sense of urgency and respond to matters timely.
Outstanding at multi-tasking, able to prioritize and work under pressure in fast paced environment
Extremely organized and detail oriented
Must have excellent verbal & written communication skills
Perform other jo-related duties as assigned
Follow up of claims development until completion and settlement.
Services as contact for Adjuster and Insured for claims related issues.
Secures loss runs for cost containment when requested by Safety Coordinator
Provides claims packets to customers and prospects as requested.
Follows company policies and procedures with respect to all essential duties and responsibilities of the job.
Special projects as requested
This job has no supervisory responsibilities.
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Education and/or Experience
High school diploma or general education degree (GED); and a minimum of three months related experience and/or training; or equivalent combination of education and experience.
Ability to read and interpret documents such as insurance policies, safety rules, operating and maintenance instructions, and procedure manuals. Ability to write routine reports and correspondence. Ability to speak effectively before groups of customers or employees of organization.
Ability to add, subtract, multiply, and divide, using whole numbers, common fractions, and decimals.
Ability to apply common sense understanding to carry out instructions furnished in written, oral, or diagram form. Ability to deal with problems involving several concrete variables in standardized situations.
To perform this job successfully, an individual should have knowledge of Contact Management systems; Database software; Internet software; Spreadsheet software and Word Processing software.
Certifications or licenses
Property and Casualty Agent license encouraged. May be obtained after one year of continuous employment
Prior experience in claims or insurance.
Physical Demands The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
While performing the duties of this Job, the employee is regularly required to sit and talk or hear. The employee must occasionally lift and/or move up to 10 pounds.