Workers’ Comp Claims Investigator & Specialist

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, 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