Claims - Workers Comp Claims Representative

Our Workers Comp Claims team is currently seeking a Claims Representative to join our Level One team in our Worcester, MA, Howell, MI, or Itasca, IL offices.  This is a full-time/non-exempt role.   POSITION OVERVIEW:   Responsible for the investigation and resolution of complex medical only and lost time claims of low complexity in accordance with policy provisions, best practices and jurisdictional requirements. Includes the input of claim data and guiding insured’s and claimants through the claim process and options. IN THIS ROLE, YOU WILL: Must have or secure and maintain appropriate states adjuster license(s) and continuing education credits. Work within specific limits and authority on assignments of moderate technical complexity. Use discretion and independent judgment in claim handling. Possess functional knowledge and skills reflective of fully competent practitioner. Identify possibly suspicious claims. Investigate, analyze, evaluate and negotiate personal and/or commercial lines claims of minimal to moderate complexity. Responsible for managing all aspects of each claim and maintaining a high level of productivity, confidentiality and customer service. Implement and coordinate the most effective management techniques to mitigate loss and expense payments. Reserving and expense authority levels are moderate. Work with the Special Investigations Unit, where appropriate. May be required to have and maintain sufficient home-based internet connection. WHAT YOU NEED TO APPLY: Typically has 1 – 3 years experience Technical knowledge in WC coverages Excellent written and verbal communication skills Knowledge of medical terminology Must possess organizational skills with regard to time management, task prioritization and integration of information from a variety of sources Excellent and proficient data entry skills High level of proficiency in Word, Excel and use of the Internet Ability to meet and/or exceed the goals and metrics of the role on a consistent basis Self-directed and self-motivated Possesses strong customer service skills and behaviors Makes decisions in an informed, confident and timely manner Maintains constructive working relationships despite differing perspectives Strong organizational and time management skills Ability to negotiate skillfully in difficult situations with both internal and external groups Demonstrates ability to win concessions without damaging relationships Demonstrates strong written and verbal communication skills. Promotes and facilitates free and open communication Understanding of applicable statutes, regulations and case law Thinks critically and anticipates, recognizes, identifies and develops solutions to problems in a timely manner Easily adapts to new or different changing situations, requirements or priorities Cultivates an environment of teamwork and collaboration Operates with latitude for un-reviewed action or decision Computer experience (MS Office, excel, word, etc) Proficient using Claims systems (i.e. CSS, PMS, etc.) Ability to use a personal computer and other standard office equipment Ability to travel as necessary Ability to sit and/or stand for extended periods Workload requirements may routinely call for work hours in excess of 40 hours per week   This job posting provides cursory examples of some of the job duties associated with this position.  The examples provided are not complete, and the position may entail other essential and job-related functions and responsibilities that employees will be required to perform.

Salary : $55,000