Claim Representative I - Central

ViziRecruiter,LLC.; Wisconsin; On-site; USD 48,000 - 81,000; Full time

Job summary

AF Group in Wisconsin seeks an entry-level professional claims handler to manage medical and indemnity benefits. The role involves evaluating compensability, setting reserves, and negotiating settlements within authority.

Qualifications include a bachelor’s degree, plus knowledge of workers’ compensation laws, medical terminology, and strong communication skills. Bilingual abilities are preferred and essential for some cases.

Qualifications

• Bachelor’s degree in a related field or equivalent experience.
• Certification or progress toward certification is highly preferred.

Responsibilities

• Verifies workers’ compensation coverage of employers and injured employees.
• Determines compensability under workers’ compensation by thorough investigation of the claim.
• Assesses causal relationship between injury and incident to ensure proper benefits.
• Facilitates return to work for the injured employee.
• Establishes timely reserves within authority based on anticipated exposure.
• Documents specifics of claims with potential for subrogation recovery.
• Manages medical bills for non-indemnity and indemnity claims.
• Negotiates settlements with attorneys or parties within authority.
• Keeps manager informed on complex files and collaborates with outside vendors.

Skills

Computers & software

Medical terminology

WC laws & regulations

Oral & written comms

Customer service

Negotiation & conflict

Prioritization & deadlines

Attention to detail

Teamwork & independence

Education

Bachelor’s degree in related field

Certification/progress toward certification preferred

Job description

Introduction

AF Group (Lansing, Mich.) and its subsidiaries are a premier provider of innovative insurance solutions. Insurance policies may be issued by any of the following companies within AF Group: Accident Fund Insurance Company of America, Accident Fund National Insurance Company, Accident Fund General Insurance Company, United Wisconsin Insurance Company, Third Coast Insurance Company, or CompWest Insurance Company.

Overview

This is the entry-level professional claim handler. Handles medical only and indemnity benefits. Exercises some discretion in the determination of compensability of claims. Considers many factors in the determination claim reserves. Negotiates and settles claims within given authority.

WORKING CONDITIONS:

Work is performed in an office setting with no unusual hazards. Minimal travel required.

PAY RANGE:Actual compensation decision relies on the consideration of internal equity, candidate’s skills and professional experience, geographic location, market, and other potential factors. It is not standard practice for an offer to be at or near the top of the range, and therefore a reasonable estimate for this role is between $48,200 - $80,750.

Responsibilities

• 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 within given authority based on anticipated financial exposure.
• Documents specifics of claims with potential for subrogation recovery, including amount of potential recovery monies.
• 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 showing relationship of treatment to the injury.
• Concludes and closes files following resolution of claims to meet internal performance standards while complying with state legislation to avoid penalties and manage expenses.
• Negotiates settlements with attorneys or injured parties within given authority at the earliest possible point to bring cases to final disposition.
• Works closely with manager on complex files or files above settlement/reserve authority.
• Manages outside vendors to ensure cost containment efforts.
• Establishes and maintainseffective workingrelationships with all internal and externalcustomers.
• Stays abreast of changes in workers’ compensation statutes, case law and rehabilitation efforts/advancements in order to accurately interpret and apply relevant laws.

This position description identifies the responsibilities and tasks typically associated with the performance of the position. Other relevant essential functions may be required.

Requirements

• Bachelor’s degree in a related field. Relevant combination of education and experience may be considered in lieu of degree.Continuous learning, as defined by the Company’s learning philosophy, is required. Certification or progress toward certification is highly preferred and encouraged.
• Minimum one year of relevant experience that provides the necessary skills, knowledge and abilities or completion of claims trainee program. Bilingual skills preferred.
  

SKILLS/KNOWLEDGE/ABILITIES (SKA) REQUIRED:

• Ability and proficiency in the use of computers and company standard software specific to position.
• Knowledge of medical and legal terminology related to the work.
• Knowledge of workers’ compensation laws and regulations, including jurisdictional laws.
• Effective oral and written communication skills.
• Effective customer service skills.
• Ability to negotiate, build consensus and resolve conflict.
• Ability to manage multiple priorities and meet established deadlines.
• Attention to detail and analytical skills.
• Ability to work independently as well as within a team.