Claims Specialist, Workers' Comp – Intermediate

Emergent Holdings, Inc.; United States; Remote; USD 57,000 - 95,000; Full time

Job summary

Emergent Holdings, Inc. is seeking a Claim Representative II to handle intermediate workers’ compensation claims, verify coverage, determine compensability, and facilitate timely settlements.

The role requires investigation, reserve setting within authority, and coordination with medical providers to ensure appropriate benefit payments. The ideal candidate has a bachelor’s degree in a related field and at least three years of workers’ compensation experience; bilingual skills are a plus.

Qualifications

• Bachelor’s degree in a related field.
• Three years’ experience in workers’ compensation claims.
• Experience in handling claims in multiple jurisdictions preferred.
• Bilingual skills preferred.

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.
• Facilitate 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 maintains effective working relationships with all internal and external customers.
• Stays abreast of changes in workers’ compensation statutes, case law, and rehabilitation efforts/advancements to accurately interpret and apply relevant laws.

Education

Bachelor’s degree in a related field

Job description

Emergent Holdings, Inc. is seeking a Claim Representative II to handle intermediate workers’ compensation claims, verify coverage, determine compensability, and facilitate timely settlements.

The role requires investigation, reserve setting within authority, and coordination with medical providers to ensure appropriate benefit payments. The ideal candidate has a bachelor’s degree in a related field and at least three years of workers’ compensation experience; bilingual skills are a plus.