W.C. Claims Representative

ACUITY, A Mutual Insurance Company; Sheboygan (WI); On-site; USD 75,000 - 90,000; Full time

Benefits offered by this job

401(k) contribution

Medical insurance

Dental insurance

Vision insurance

Life and disability insurance

Paid time off

Employee Assistance Program

Job summary

Acuity, a Mutual Insurance Company, seeks a Workers' Compensation Claims Representative to investigate, evaluate, direct, and control workers’ compensation claims from multiple jurisdictions. You will provide superior customer service to policyholders and agents while applying claims concepts, reviewing medical reports, subrogation opportunities, and maintaining thorough file documentation.

Minimum 2-3 years of WC claims experience, excellent written and verbal communication, and a solid

Qualifications

• 2-3 years of experience handling Workers’ Compensation claims preferred.
• Strong written and verbal communication skills.
• Familiarity with WC statutes and case law.

Responsibilities

• Understand and apply customer service concepts and requirements.
• Conduct thorough initial investigations to determine coverage, compensability, subrogation, and fraud.
• Read and evaluate medical reports to determine extent of injury and treatment plans.
• Provide direction and action planning with timely intervention.
• Adhere to company reserving guidelines and understand reserving concepts.
• Utilize managed care cost containment programs, services, and vendors.
• Identify subrogation recovery opportunities.
• Apply legal and statutory concepts of applicable jurisdictions.
• Maintain consistent file documentation with queue and calendar systems.
• Demonstrate superior communication in all interactions with insureds and agents.
• Conduct claim reviews independently with insureds and agents.
• Handle increasingly complex issues and mentor others when appropriate.
• Maintain professionalism and positive attitude.
• Research independently and demonstrate creativity.
• Maintain regular and predictable attendance.

Skills

Customer service

Communication skills

Investigation

Subrogation awareness

Reading medical reports

Medical terminology

Time management

Self-starter

Job description

Acuity is seeking a Workers' Compensation Claims Representative to investigate, evaluate, direct, and control Workers’ Compensation claims from multiple jurisdictions. In this role, you will provide superior customer service to our policyholders and agents.

ESSENTIAL RESPONSIBILITIES:

• Understands and consistently applies customer service concepts and requirements.
• Conducts thorough initial investigations to determine coverage, compensability, subrogation, and fraud.
• Understands basic anatomy and medical terminology. Able to read and evaluate medical reports to determine extent of injury and treatment plans. Able to recognize, research, and analyze complex medical issues.
• Implements pro-active direction and control with timely intervention and action planning.
• Understands basic reserving concepts and adheres to company reserving guidelines.
• Effectively utilizes managed care cost containment programs, services, and vendors. Consistently provides direction to assure control of costs.
• Recognizes and aggressively pursues all potential subrogation recovery opportunities.
• Understands and consistently applies legal and statutory concepts of the applicable jurisdiction.
• Provides consistent meaningful file documentation with effective use of the queue and calendar system.
• Demonstrates superior communication skills in all aspects of the position. Places emphasis on meaningful correspondence and effective customer service interactions.
• Conducts Claim Reviews independently with Insureds and Agents.
• Demonstrate interest and ability to handle increasingly more complex issues.
• Maintain a positive attitude and exhibit consistent professionalism.
• Demonstrate creativity and independently conduct research.
• Regular and predictable attendance.
• Performs other duties as assigned.

EDUCATION:

EXPERIENCE:

Minimum 2-3 years of experience in handling Workers’ Compensation claims preferred.

OTHER QUALIFICATIONS:

• Thorough understanding of personal computing, typing skills, technology and use of mobile devices.
• Basic understanding of medical terminology and treatment, physiology, and anatomy.
• Understanding of WC statutes and case law.
• Someone who has demonstrated sustained excellence over a prolonged period of time.
• Excellent written and verbal communication skills.
• Independently conducts claim reviews & service presentations to agents and potential new insureds.
• Independently handles litigated claims including attending prehearings, mediations, and hearings.
• Has served as a mentor for a new employee or willingness to do so by volunteering with job shadowing and training activities.
• Participates in or conducts a training session for unit and/or department.
• Has accompanied SIU on field claim investigations.
• Ability and willingness to provide quality customer service.
• Must be a self-starter, take on and create new opportunities.
• Ability to work both independently and in collaboration with others.
• Proven organizational and time management skills.

*Acuity does not sponsor applicants for U.S. work authorization.*

This job is classified as exempt.

The salary range for this position is $75,000 - $90,000 annually. This salary range is an estimate, and the actual salary will vary based on applicant’s education, experience, knowledge, skills, and abilities.

For this role, Acuity offers a comprehensive benefits package, including a generous 401(k) contribution, medical, dental, vision, life and disability insurance, paid time off, an Employee Assistance Program, and more. A full description of benefits and eligibility will be provided to candidates during the hiring process.

We are an Equal Employment Opportunity employer. Applicants and employees are considered for positions and are evaluated without regard to mental or physical disability, race, color, religion, gender, national origin, age, genetic information, military or veteran status, sexual orientation, marital status or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.

Acuity will include at least one in-person interview during the hiring process for all positions.

If you have a disability and require reasonable accommodations to apply or during the interview process, including for in-person interviews, please contact our Talent Acquisition team at [e-mail]. Acuity is dedicated to offering reasonable accommodations during our recruitment process for qualified individuals.

Equal Opportunity Employer
This employer is required to notify all applicants of their rights pursuant to federal employment laws.For further information, please review the Know Your Rights notice from the Department of Labor.