Workers Compensation Claims Representative

∙ Elijah House Foundation; Goodlettsville (TN); On-site; USD 60,968 - 74,517; Full time

Job summary

Dollar General seeks a Workers’ Compensation Claims Specialist to manage claims from filing to resolution. You will investigate incidents, determine compensability, coordinate medical and disability management, and ensure regulatory compliance while working with employees, store personnel, medical providers, attorneys, and case managers.

Responsibilities include interviewing workers within 24 hours, evaluating exposure, coordinating return-to-work, approving benefits, and minimizing expenses.

Qualifications

• Extensive claim handling experience with emphasis on workers’ compensation.
• Complex problem solving and strong decision-making skills.
• Strong organizational skills and the ability to prioritize.
• Customer service oriented and works well in a team environment.
• Excellent written and verbal communication skills.
• Must be detail oriented and able to meet deadlines.
• Ability to handle confrontational situations in a mature and professional manner.
• Working knowledge of medical and legal terminology.
• Working knowledge of Microsoft Office programs.

Responsibilities

• Interview injured employees, store personnel, and providers within 24 hours to assess compensability.
• Evaluate claim exposure and develop action plans for medical and disability management.
• Coordinate light- or full-duty return-to-work with stakeholders and manage benefits.
• Assess medical care requests for causation and timely payment of benefits.
• Coordinate with defense attorneys, case managers, and investigators to minimize costs.
• Develop a proactive strategic plan for each claim’s life cycle and resolve efficiently.
• Maintain knowledge of state workers’ comp laws and licensing.

Skills

Claim handling

Problem solving

Decision making

Organizational skills

Customer service

Communication

Attention to detail

Confrontation management

Medical terminology

MS Office

Education

College degree preferred

Tools

Microsoft Office

Job description

Work Where You Matter

At Dollar General, our mission is Serving Others! We value each and every one of our employees. Whether you are looking to launch a new career in one of our many convenient Store locations, Distribution Centers, Store Support Center or with our Private Fleet Team, we are proud to provide a wide range of career opportunities. We are not just a retail company; we are a company that values the unique strengths and perspectives that each individual brings. Your difference truly makes a difference at Dollar General. How would you like to Serve? Join the Dollar General Journey and see how your career can thrive.

Company Overview

• Summary of role: Responsible for managing workers’ compensation claims by investigating reported incidents, determining compensability, coordinating medical and disability management, evaluating claim exposure, and ensuring compliance with state laws and reporting requirements. This role partners with injured employees, store personnel, medical providers, attorneys, case managers, and other service providers to support return-to-work efforts, manage benefits, control claim costs, develop strategic resolution plans, and maintain compliance with applicable workers’ compensation regulations and licensing requirements.

Job Details

• Conduct interviews with injured employees, store personnel, and medical care providers within 24 hours of receiving a reported incident. Utilize complex problem-solving, critical-thinking, and organizational skills to evaluate compensability and effectively manage claim assignments. Maintain communication with appropriate parties throughout the life of the claim to support proper medical and disability management and resolution. 20%
• Utilize professional experience and investigative skills to evaluate claim exposure and develop action plans related to medical management, disability management, and claim resolution. 20%
• Proactively coordinate and communicate with physicians, injured employees, and store personnel regarding light-duty or full-duty return-to-work opportunities, payment of appropriate benefits, and utilization of in-house and field nurse resources for medical and disability management. 15%
• Evaluate requests for medical care to determine causation and relatedness in compliance with state requirements. Timely assess and pay medical and indemnity benefits in accordance with applicable laws and complete all required state reporting. 15%
• Coordinate and communicate with service providers, including defense attorneys, medical case managers, and private investigators, to minimize claim expenses and maximize outcomes. 10%
• Develop and maintain a proactive strategic action plan throughout the life of each claim. Resolve claims efficiently and provide recommendations for claim resolution in accordance with best practices and state requirements. 10%
• Maintain working knowledge of multiple state workers’ compensation laws and regulations and maintain all required state licensing. 10%

Qualifications

• Extensive claim handling experience with emphasis on workers’ compensation.
• Possess complex problem solving and strong decision-making skills.
• Strong organizational skills and the ability to prioritize.
• Customer service oriented and works well in a team environment.
• Excellent written and verbal communication skills.
• Must be detail oriented and able to meet deadlines.
• Ability to handle confrontational situations in a mature and professional manner.
• Working knowledge of medical and legal terminology.
• Working knowledge of Microsoft Office programs.

Must have extensive insurance claims background and experience with emphasis on workers’ compensation

1-2 years of related experience preferred. College degree preferred but not required. Equal education and experience may be considered.

**The compensation for this role is $67,743 and eligible for a company performance bonus**