Workers' Compensation Claims Representative III

This is a fully remote position, open to applicants in Illinois, +5 more states.

📋 Description

• Oversee intricate workers’ compensation claims that involve significant financial risk, sensitive matters, or prolonged life cycles.

• Conduct investigations into coverage and compensability, ensuring comprehensive documentation and adherence to state regulations.

• Manage advanced medical case management, coordinating with Nurse Case Managers and external service providers.

• Create and execute Return-to-Work strategies for high-risk claims, collaborating with vocational consultants and legal advisors.

• Detect and examine possible fraud and subrogation possibilities, working alongside the Special Investigation Unit.

• Set up and maintain precise claim reserves within authorized limits, ensuring prompt adjustments to evolving situations.

• Assess and negotiate settlements within granted authority levels, including structured settlements and compliance with Medicare.

• Work in conjunction with legal counsel to handle litigation and ensure compliance with MEM guidelines.

• Keep accurate system records and generate reports for management regarding high-profile claims.

• Promote interdepartmental collaboration with Underwriting, Premium Consultation, and Loss Prevention teams.

• Mentor and train junior adjusters, fostering professional development and team cohesion.

⛳️ Requirements

• A high school diploma or equivalent is required; a bachelor’s degree is preferred.

• Associate in Claims (AIC) designation is preferred.

• A valid driver’s license is required; a Texas-All Lines license is preferred.

• 3–5 years of experience in claims handling, particularly in Workers’ Compensation, with a preference for Missouri experience.

🏝️ Benefits

• Health Plans: Medical, Dental, and Vision, including fertility benefits, fully covered preventative care, and adult orthodontia.

• Employer-Paid Life and Disability Benefits: Life Insurance (3x base salary), AD&D, Short and Long-term Disability.

• Wellness and Recognition Program: Employer-funded incentives for employees and their spouses.

• Flexible Spending Account and Dependent Care options.

• Health Savings Account: Significant employer contribution.

• Time Away from Work: Generous PTO, 11 Holidays + 4 Early Releases, 16 Hours Volunteer Time Off, 20 Days Paid Parental Leave, as well as Marriage, Bereavement, and Jury Duty leave.

• Employee Assistance Programs.

• 401k Retirement Plan: Employer matching and profit sharing.

• Adoption Assistance and Tuition Assistance.