[Hiring] Workers' Comp Claim Representative III @Emergent Holdings

Role Description

This is the advanced level of the claim handler career path. Investigates claims and exercises significant discretion in the determination of compensability of claims. May handle large, more complex customers requiring high touch, labor intensive claim service. Considers many factors in the determination claim reserves. Negotiates and settles claims within given authority. Mentors lower-level claim handlers. Coordinates special projects and provides guidance to others. Candidate must have California experience.

Qualifications

• Relevant combination of education and experience may be considered in lieu of degree.
• Bachelor’s degree in a related field.
• Continuous learning, as defined by the Company’s learning philosophy, is required.
• Certification or progress toward certification is highly preferred and encouraged.
• Five (5) years of experience in a workers’ compensation claims environment.
• Experience handling claims in multiple jurisdictions preferred.
• Bilingual skills preferred.
• OR Two (2) years of AF Group Claims Representative II experience.

Requirements

• Verifies workers’ compensation coverage of employers and injured employees.
• Determines compensability under workers’ compensation by thorough investigation of the claim.
• Determines causal relationship between the reported injury and the incident to ensure appropriate payment of benefits.
• Facilitates return to work for the injured employee.
• Establishes timely and appropriate reserves based on the profile of the claim.
• Documents specifics of claims with potential for subrogation recovery.
• Manages medical bills for non-indemnity and indemnity claims directly associated with the claimed injury.
• Approves payment based on knowledge of the treatment plan and medical support.
• Concludes and closes files following resolution of claims.
• Negotiates settlements with attorneys or injured parties within given authority.
• Works closely with manager on complex files or files above settlement/reserve authority.
• Manages outside vendors to ensure cost containment efforts.
• Establishes and maintains effective working relationships with all internal and external customers.
• Stays abreast of changes in workers’ compensation statutes, case law, and rehabilitation efforts.
• Mentors team members.
• Conducts audits of claim files.
• Acts as a backup for team leader.
• Coordinates special projects.

Benefits

• Actual compensation decision relies on the consideration of internal equity, candidate’s skills and professional experience, geographic location, market, and other potential factors.
• Reasonable estimate for this role is between $64,900 and $108,700.

Company Description

We are an Equal Opportunity Employer. We will not tolerate discrimination or harassment in any form. Candidates for the position stated above are hired on an "at will" basis. Nothing herein is intended to create a contract.