Workers compensation Rep

Optimal Solution Company; Claycomo (MO); On-site; USD 52,000 - 75,000; Full time

Job summary

Optimal Solution Company in Missouri is seeking a Workers' Compensation Rep to serve as the primary claims handler at the plant, delivering excellent customer service and effective loss cost management.

The role requires 3–5 years of Missouri WC claims adjusting, a high school diploma, and preference for a bachelor's degree. You will analyze complex claims, set reserves, process payments, and coordinate investigations to ensure timely, cost-efficient resolutions onsite.

Qualifications

• Analyze and process complex or technically difficult workers' compensation claims by investigating and gathering information to determine exposure.
• Ability to handle a full case load, with proven ability to handle cases of increased severity.
• Workers' Compensation Lost Time claim handling experience

Responsibilities

• Manage claim reserves to ensure adequacy throughout the life of the claim.
• Calculate and pay benefits due; approve and make timely claim payments and adjustments.
• Coordinate vendor referrals for additional investigation and/or litigation management.
• Use cost containment techniques including strategic vendor partnerships to reduce overall cost of claims.
• Manage claim recoveries, including subrogation and offsets.
• Report claims to the excess carrier and communicate activity with claimants and clients.
• Ensure claim files are properly documented and coded.
• Refer cases to supervisor/management as appropriate.

Job description

Job Title:

Workers Compensation Rep

Position Description:

Primary Workers' Compensation Claims Handler at the Plant with a focus on excellent customer service, quality claims handling, and loss cost management. Plant-based position

Skills Required:

Workers' Compensation - Lost time indemnity claims as a WC Adjuster, Onsite

Experience Required:

3-5 years of Missouri Workers' Compensation Claims Adjusting experience

Education Required:

High School Diploma / GED

Education Preferred:

Bachelor's Degree

Additional Information :

Analyze and process complex or technically difficult workers' compensation claims by investigating and gathering information to determine the exposure on the claim

Ability to handle a full case load, with proven ability to handle cases of increased severity. Workers' Compensation Lost Time claim handling experience

Manage claims through well-developed action plans to ensure timely and cost-effective resolutions.

Calculate and assign timely and appropriate reserves to claims; manages reserve adequacy throughout the life of the claim.

Calculate and pay benefits due; approve and make timely claim payments and adjustments; and settle clams within designated authority level.

Prepare necessary state fillings within statutory limits.

Coordinate vendor referrals for additional investigation and/or litigation management.

Use appropriate cost containment techniques including strategic vendor partnerships to reduce overall cost of claims.

Manage claim recoveries, including but not limited to: subrogation, Second Injury Fund excess recoveries and Social Security and Medicare offsets.

Report claims to the excess carrier.

Communicate claim activity and processing with the claimant and the client.

Ensure claim files are properly documented, and claims coding is correct.

Refer cases as appropriate to supervisor and management.

*Fully Onsite.