Responsible for handling low to moderately complex workers’ compensation indemnity claims within specific state jurisdictions. Investigates, determines compensability, manages and resolves assigned workers’ compensation indemnity claims
Investigates and confirms or denies coverage and compensability of claims presented through contact with claimant, insured and other involved parties
- Regularly reviews and makes appropriate decisions regarding medical bills presented, wage claims and other daily claims items to keep file up to date
- Manages the medical aspects of assigned claims with a focus on return to work and end of treatment
- Refers appropriate files for task assignments to approved vendors for medical management, special investigative needs, etc., within assigned authority. Monitors status and quality of work performed
- Make recommendations to the Worker’s Compensation Supervisor on claims issues which exceed personal authorization
- Properly evaluates exposures on claims and takes appropriate reserving action in accordance with company guidelines, applicable state requirements, and within designated authority level
- Negotiates claims to a conclusion, within assigned authority level
- Effectively manages claims in litigation
- Controls expenses on all worker’s compensation claims
- Works with the Subrogation Analyst to maximize all recoveries on eligible claims
Bachelor's degree or equivalent experience.
3-5 years workers’ compensation indemnity claim handling experience.
Tower Group Companies - 2 years ago
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