Senior Claims Representative – Medical Only, Workers Compensation

This is a fully remote position, open to applicants in United States.

📋 Description

• Investigate, assess, and oversee workers’ compensation medical-only claims from the point of initial reporting through to resolution.

• Confirm coverage and collect pertinent information to ascertain compensability and the appropriate strategies for claim handling.

• Maintain consistent verbal and written communication with injured workers, employers, medical providers, and other stakeholders involved in the claims process.

• Authorize or reject payment of medical invoices in line with company policies and relevant jurisdictional regulations.

• Establish and oversee claim reserves within designated authority levels, including approvals for reserves up to $10,000.

• Ensure timely and precise documentation of claims, effective file management, and resolution activities.

• Evaluate medical information and claim specifics to promote favorable claim outcomes and manage costs.

• Manage medical-only claims across Minnesota, Iowa, Nebraska, South Dakota, Kansas, and Missouri while ensuring adherence to state-specific regulations.

• Provide support for claim administration in Midwestern jurisdictions as business requirements dictate.

• Prioritize and handle a substantial caseload while meeting expectations for productivity, quality, and service.

• Collaborate with both internal partners and external stakeholders to facilitate swift and effective claim resolutions.

• Identify issues that need escalation and propose appropriate measures to mitigate risk and ensure compliance.

⛳️ Requirements

• A high school diploma is required.

• Typically, at least 2 years of experience in handling workers’ compensation medical-only claims.

• Preferred experience in managing claims across Minnesota, Iowa, Nebraska, South Dakota, Kansas, and Missouri.

• Strong understanding of workers’ compensation claims handling practices, medical bill review, and claim investigation techniques.

• Exceptional written and verbal communication skills, capable of effectively engaging with a diverse range of internal and external stakeholders.

• Proven ability to work autonomously in a remote setting, manage multiple priorities, and uphold accuracy in a fast-paced environment.

• Must be authorized to work in the United States without requiring current or future employment visa sponsorship.

🏝️ Benefits

• Medical coverage

• Dental coverage

• Vision coverage

• Wellness plans

• Parental leave

• Adoption assistance

• Tuition reimbursement

• Paid Time Off

• Paid holidays

• 401(k) plan with company match

• Employee stock purchase plan

• Commuter benefits