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Summary:
Participation in a structured training program that involves both classroom and hands on experience with the daily duties of a claims operation. Training will be structured for ½ day lecture and the remainder of the day working with claims staff to learn about handling workers compensation claims. Claims will be assigned claims after successful completion of three months of training. On-going training will be provided with a goal of passing the SIP exam within the first year.
Essential Duties and Responsibilities Upon Completion of Training:
- Three-point contact, initial investigation, initial benefit determination.
- Ability to identify and address questionable (AOE/COE) claims.
- Establish and monitor reserves at periodic intervals.
- Prepare claims status report to carriers at 90-day intervals.
- Ability to manage and direct medical care, including strategies to maintain medical control and objection when appropriate.
- Identify and rate permanent disability.
- Vocational Rehabilitation file management
- Negotiate and finalize claim settlements as well as lien settlements.
- Identify and manage subrogation issues on workers’ compensation claims.
- Work independently and in a fast paced environment.
Competency:
- To perform the job successfully, an individual should demonstrate the following competencies:
- Problem Solving - Identifies and resolves problems in a timely manner; Gathers and analyzes information skillfully; Develops alternative solutions; Works well in group problem solving situations; Uses reason even when dealing with emotional topics.
- Customer Service - Manages difficult or emotional customer situations; Responds promptly to customer needs; Solicits customer feedback to improve service; Responds to requests for service and assistance; Meets commitments.
- Interpersonal - Focuses on solving conflict, not blaming; Maintains confidentiality; Listens to others without interrupting; Keeps emotions under control; Remains open to others' ideas and tries new things.
- Team Work - Supports everyone's efforts to succeed.
Qualification Requirements:
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.
