Claims Associate – Workers Compensation

This is a fully remote position, open to applicants in North Carolina.

📋 Description

• Evaluate reported lower-level workers' compensation claims to ascertain the benefits owed

• Ensure the continuous adjudication of claims in accordance with company standards and industry best practices

• Adjust medical-only claims and minor lost-time workers' compensation claims with close supervision

• Assist claims representatives, examiners, and leads with larger or more intricate claims

• Process workers' compensation claims, determine compensability and benefits owed, oversee reserve accuracy, and submit necessary documentation to the state agency

• Communicate claim actions and processing updates with claimants, clients, and relevant medical contacts

• Ensure that claim files are thoroughly documented and that claims coding is accurate

• Process routine payments, prescriptions, and status reports for lifetime medical claims and/or claims with defined periods

• Maintain professional relationships with clients

⛳️ Requirements

• High School Diploma or GED is mandatory

• Bachelor's degree from an accredited institution is preferred

• Relevant professional certification applicable to the line of business is preferred

• Minimum of 1 year of claims management experience or a suitable combination of education and experience is required

• Ability to think clearly and conceptually

• Excellent judgment, problem-solving, troubleshooting, analysis, and discretion

• Capability to manage work-related stress

• Ability to handle multiple priorities at the same time

• Ability to meet deadlines consistently

• Proficiency in computer keyboarding

• Willingness to travel as necessary

• Adequate hearing, vision, and speaking abilities

🏝️ Benefits

• Flexible work schedule

• Referral incentive program

• Opportunities for career development and promotional growth

• A diverse and comprehensive benefits package including medical, dental, vision, and 401K available from day one

• Reasonable accommodations will be considered when applicable and appropriate