Senior Claim Representative, Workers' Compensation

Jobtailor; Mount Carmel (KY); On-site; USD 80,000 - 110,000; Full time

Job summary

Jobtailor seeks an experienced Workers’ Compensation Claims Manager to oversee complex claims in the Kentucky area. You will verify coverage, investigate, determine compensability, and identify subrogation opportunities.

Responsibilities include maintaining reserves up to $75,000, preparing regulatory reports, supporting return-to-work initiatives, and communicating with clients, agents, and coworkers to ensure timely resolutions.

Qualifications

• Bachelor’s degree required; five years’ workers’ compensation claims management experience or ten years in a professional claims capacity without a degree.

Responsibilities

• Manage complex workers’ compensation claims, including verification of coverage and investigations.
• Establish and maintain accurate case reserves up to $75,000.
• Prepare regulatory reports and required forms.
• Maintain regular contact with injured workers, agents, customers, and co-workers.
• Perform return-to-work activities and establish guidelines.

Skills

Negotiation

Empathic Listening

Effective Communication

Time Management

Organization

Attention to detail

Problem Solving

Analytical Thinking

Education

Bachelor’s degree

Tools

Microsoft Office

Job description

Responsibilities

• Execute the Company’s ecovery® Return to Wellness philosophy and business model
• Manage all aspects of assigned complex workers’ compensation claims, including verifying coverage, investigating, managing, and resolving claims
• Establish and maintain accurate case reserves with authority up to $75,000
• Complete proactive ongoing claim management activities and maintain regular contact with injured workers, agents, customers, and co-workers
• Investigate claims, assess coverage, determine injury nature and extent, make compensability determinations, and identify subrogation potential
• Prepare reports and forms required by jurisdictional regulations and Company procedures
• Prepare claim status reports for customers, agents, underwriters, reinsurers, and others
• Attend point-of-sale presentations and claim review meetings
• Manage Return to Wellness initiatives and establish, follow, and achieve return-to-work guidelines
• Attend monthly large account team meetings and discuss results, profitability, and renewal strategy
• Assist with company projects and participate in insurance-related professional development events

Requirements

• Bachelor’s degree and a minimum of five years’ experience in workers’ compensation claims management, or a minimum of ten years working in a professional claims capacity in workers’ compensation without a degree
• Advanced certification or training preferred
• Comprehensive knowledge of applicable state laws and industry standards
• Ability to independently attend insurance and industry/business functions
• Proficiency in Microsoft Office computer applications
• Ability to learn new computer software applications
• Advanced analytical ability to analyze and interpret information and make appropriate decisions regarding claims payments
• Excellent organization and time management skills
• Excellent negotiation skills
• Attention to detail in processing information, establishing priorities, and meeting deadlines
• Excellent analytical and problem-solving skills
• Ability to assess urgency and importance and take appropriate action
• Empathic listening and ability to build mutual understanding and trust
• Effective and professional verbal and written communication with various constituencies and organizational levels

Core Competencies

Demonstrates expertise in managing complex workers' compensation claims, including coverage verification, claims investigation, and resolution. Proficient in maintaining case reserves, preparing regulatory reports, and executing return-to-work initiatives while ensuring compliance with state laws and industry standards.

Highest-signal resume keywords

• Workers' Compensation Claims Management
• Case Reserve Management
• Regulatory Reporting
• Advanced Analytical Skills
• Negotiation Skills

Hard Skills

• Claims Investigation
• Coverage Assessment
• Compensability Determination
• Subrogation Identification
• Report Preparation
• Return-to-Work Guidelines
• Microsoft Office Proficiency
• Analytical Problem-Solving

Soft Skills

• Excellent Organization
• Time Management
• Empathic Listening
• Effective Communication

Certifications & Qualifications

• Advanced Certification or Training

Industry Keywords

• Workers' Compensation
• State Laws
• Industry Standards
• Claims Management
• Insurance Functions