SR Claims Representative
SFM -- The Work Comp Experts. Work Somewhere You Love.
Since 1983, SFM’s mission has been to be the workers’ compensation partner of choice for agents, employers, and their workers. While we’ve expanded to over 20,000 customers in the Midwest, and have grown our offerings to include vocational rehab, safe patient handling, loss prevention, medical services (and more!), our focus continues to be unrivaled customer service, injury prevention, and results.
The Senior Claims Representative works on Third Party Administration claims. You will manage investigations and determine liability regarding various worker’s compensation claims. In this role, you will determine appropriate reserves, authorize payment of medical and wage loss benefits and assign, direct, and monitor medical, rehabilitation and legal services. You will be an active team member within a multi-functional team and respond to customer inquiries and conduct field visits with TPA clients, brokers and injured workers.
- Manage claims promptly and effectively in accordance with the TPA client’s special handling instructions, state applicable workers’ compensation statutes and Company best practices to ensure claims are handled timely, cost effective and equitable closure of issues and/or claims.
- Establish initial and ongoing case reserves that accurately reflect file exposure in accordance with client expectations and special handling instructions per contract and/or TPA client.
- Provide excellent customer service to all customers and comply with customer service standards, while responding promptly to resolve complaints or problems and adhere to service-level agreements per TPA client.
- Audit claim files for self and other representatives, when needed.
- Share knowledge and grow professionally by handling claims from multiple jurisdictions, contributing to intercompany communications, presenting information to other claim representatives, and training of new claim representatives.
- Demonstrate guidance to other team members regarding file reserves and settlement reviews.
We’re looking for:
- Bachelor’s degree in insurance, risk management, business, psychology or related field preferred.
- Five to eight years of claim management experience or equivalent combination of education and experience.
- Professional insurance designations (CPCU, ARM), preferred.
- Previous TPA experience is a plus.
- Demonstrates a working knowledge of state applicable Workers’ Compensation Act and its application to claims administration.
- Demonstrates a working knowledge and skill in state regulatory reporting.
- Understanding of insurance finance and underwriting helpful.
- Exceptional oral and written communication skills.
- Demonstrated successful ability to build positive relationships and partnerships within department, across the organization and with external customers.
- Ability to assimilate, understand and analyze information from a variety of sources.
- Strong math skills.
- Excellent investigation and negotiation skills.
- Excellent Problem solving and decision making skills
- PC literate, including Microsoft Office products
- Effective prioritization, organization, and time management skills.
- Demonstrated experience working in a customer focused environment.
Work takes place in a paperless environment within an office, using a standard office equipment such as computers, phones, photocopies, which requires being stationary for extended periods of time. While performing the duties of this job, the employee is regularly required to talk or hear. The employee frequently is required to stand; walk; use hands and fingers, handle or feel; and reach with hands and arms and work with close vision. This position requires the ability to occasionally lift office products and supplies, up to 20 pounds. Work is performed indoors with little to no exposure to extreme outdoor weather conditions.
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions
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