Claim Processor - Workers Compensation

churchmutual; Wisconsin; On-site; USD 42,000 - 62,000; Full time

Job summary

Church Mutual is seeking a Claims Processor to handle workers' compensation claims with accuracy and service focus. Responsibilities include processing new claims, verifying coverage, entering data, establishing reserves, and issuing payments in line with state laws and internal guidelines.

The ideal candidate has 2 years in insurance processing or equivalent customer service, familiarity with workers' compensation, and strong communication skills to coordinate with insureds and claimants by

Qualifications

• Two years of insurance processing and/or equivalent customer service work experience.
• Prior workers compensation claim processing experience is preferred.

Responsibilities

• Process newly reported workers compensation claims, initiate basic claim investigation, and redirect complex claims as needed.
• Perform Claim Processing System entry and maintenance: file setup, coverage verification, coding, reserves, and payments.
• Verify coverage and determine our obligations to insureds/claimants.
• Review claims to determine type, documentation, amount due, and reserves.
• Establish and monitor case reserves throughout the claim life cycle.
• Refer subrogation opportunities to the Subrogation Specialist when appropriate.
• Provide additional instruction to insured or request further information.
• Submit state filings and issue required notices and letters.
• Complete the claim process by reviewing documentation and making payments.
• Assist other claim handlers as requested.

Skills

Insurance processing

Customer service

Attention to detail

Communication skills

Education

High school diploma

Associate degree preferred

Tools

Claim Processing System

Job description

What you'll be doing:

In accordance with application of state and federal laws and company best practices, provide claimants and insureds with clear and correct instructions regarding the workers compensation claim process. Process basic claims by verifying coverage, obtaining and documenting necessary information for the claim, and issuing appropriate payments as directed.

On any given day, you'll:

• Process newly reported workers compensation claims, initiate basic claim investigation, and redirect moderate and complex claims to a higher level Claim Representative as required.
• Perform Claim Processing System entry and maintenance, including file setup, coverage verification, applicable coding, establishing reserves, and issuing payments.
• Verify coverage and determine our obligation(s) to the insured and/or claimant.
• Review claims to determine type of claim presented, claim documentation/evidence presented, amount of claim, or amount due.
• Establish and monitor case reserves for adequacy during the life of the claim.
• Review loss for subrogation potential and refer to the Subrogation Specialist, if appropriate.
• Provide additional instruction to insured or request additional information.
• Submit necessary state filings and create and send appropriate required state notices and letters.
• Complete the claim process by obtaining and reviewing support documentation in accordance with existing state laws and fee schedules and make appropriate payments.
• Assist other claim handlers as requested.

Here's what we expect:

• Two years of insurance processing and/or equivalent customer service work experience.
• Prior workers compensation claim processing experience is preferred.

Education:

• High school diploma or equivalent is required. Associate degree in insurance or business preferred.
• Additional courses in insurance and/or medical terminology desirable.

Necessary Knowledge and Abilities:

• Ability to obtain and maintain state adjusting license requirements and complete continuing education requirements.
• Ability to deal effectively and provide positive customer service with insureds and claimants by phone, email, and in writing.
• Proficient keyboarding skills.
• Able and willing to follow instructions.
• Possess a positive attitude.
• Ability to handle rush or unexpected assignments.
• Ability to acquire knowledge of insurance terminology.

Church Mutual is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran or disability status.

Exact compensation will vary based on consideration of a variety of factors including education, skills, experience, and location.