Responsible for the investigation and adjustment of assigned workers compensation claims. This position may be used as an advanced training position for future consideration for promotion to a Work Comp Claim Rep II or more senior level claim position. Accountable for the quality of claim services as perceived by CCMSI clients and within our corporate claim standards.
Essential Duties & Responsibilities:
Investigate and adjust workers compensation claims in accordance with established claims handling procedures using CCMSI guidelines and direct supervision.
Review medical, legal and miscellaneous invoices to determine if reasonable and related to the ongoing workers compensation claims. Negotiate any disputed bills for resolution.
Authorize and make payment of workers compensation claims utilizing a claim payment program in accordance with industry standards and within settlement authority.
Negotiate settlements with claimants and attorneys in accordance with client's authorization.
Assist in selection and supervision of defense attorneys.
Assess and monitor subrogation claims for resolution.
Prepare reports detailing claims, payments and reserves.
Provide reports and monitor files, as required by excess insurers.
Compliance with Service Commitments as established by team.
Delivery of quality claim service to clients.
Performs other duties as assigned.
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skills, and/or abilities required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Excellent oral and written communication skills. Individual must be a self-starter with strong organizational abilities. Ability to coordinate and prioritize required. Flexibility, initiative, and the ability to work with a minimum of direct supervision a must. Discretion and confidentiality required. Ability to work as a team member in a rapidly changing environment.
Reliable, predictable attendance within client service hours for the performance of this position.
Responsive to internal and external client needs.
Ability to clearly communicate verbally and/or in writing both internally and externally.
Education and/or Experience
3 or more years of workers compensation claim experience or other related industry experience is required.
Associates degree is preferred.
Proficient using Microsoft Office programs such as: Word, Excel, Outlook, etc.
Certificates, Licenses, Registrations
About Illinois Public Risk Fund
Illinois Workers' Compensation Intergovernmental Pool