Workers' Compensation Claim Representative I, REMOTE

United Heartland Inc.; United States; Remote; USD 47,000 - 79,000; Full time

Job summary

Join a forward-thinking company as a Workers' Compensation Claim Representative I. This entry-level role involves handling medical claims and indemnity benefits while exercising discretion in claim determinations. You will work closely with various stakeholders to ensure timely and appropriate resolutions, manage relationships, and stay updated on relevant laws. This is a fantastic opportunity to grow in the insurance industry and develop your skills in a supportive environment. If you are detail-oriented and eager to make a difference, this role is an excellent fit for you.

Qualifications

• Bachelor’s degree or equivalent experience required.
• Minimum one year relevant experience or claims trainee program completion.

Responsibilities

• Verifies coverage and determines compensability of claims.
• Negotiates settlements and manages medical bills for claims.
• Documents claims specifics and maintains effective relationships.

Skills

Computer proficiency

Knowledge of medical terminology

Knowledge of legal terminology

Knowledge of workers’ compensation laws

Effective communication skills

Customer service skills

Negotiation skills

Analytical skills

Attention to detail

Ability to manage multiple priorities

Education

Bachelor’s degree in a related field

Relevant combination of education and experience

Tools

Company standard software

Job description

Join to apply for the Workers' Compensation Claim Representative I, REMOTE role at United Heartland.

JOB DESCRIPTION
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 of claim reserves. Negotiates and settles claims within given authority.

Responsibilities/Tasks

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

Employment Qualifications

EDUCATION OR EQUIVALENT EXPERIENCE:
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.

Experience
Minimum one year 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.

Working Conditions
Work is performed in an office/remote setting with no unusual hazards. Minimal travel required.

The qualifications listed above are intended to represent the minimum education, experience, skills, knowledge, and ability levels associated with performing the duties and responsibilities contained in this job description.

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 $47,000 and $78,800.

We are an Equal Opportunity Employer. Diversity is valued and we will not tolerate discrimination or harassment in any form. Candidates for the position stated above are hired on an "at will" basis. Nothing herein is intended to create a contract.

About The Team
United Wisconsin Insurance Company

Seniority level: Entry level

Employment type: Full-time

Job function: Human Resources

Industries: Insurance