Work Comp 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.
As a Work Comp Claims Representative handling Third Party Claims, you will manage an assigned caseload from self-insured clients. You will investigate and determine liability on claims of reported injury or occupational disease and direct payment of wage loss and medical benefits while handling all other aspects of the claim. You will be an active team member of a multi-functional team. As an adjuster, you will be responsible for communicating with a wide variety of individuals which includes brokers, legal counsel, employers, physicians, nurses, rehabilitation consultants and injured workers. If you want to help people and make a difference, SFM is a great place for you.
- Authorize payment of medical and wage loss benefits.
- Assign, direct, and manage medical, rehabilitation, investigative and legal services while following company best practices.
- Conduct field visits with TPA clients, brokers and injured workers.
- Provide customer service to all customers and comply with customer service standards while responding promptly to resolve complaints or problems and follow the agreement per each TPA client.
- Set and monitor case reserves to ensure that they accurately reflect file exposure in accordance with client expectations and special handling instructions per contract and/or TPA client.
- Manage claims promptly and effectively in accordance with the TPA client’s special handling instructions, state applicable workers’ compensation statutes and Company best practices reflecting timely, cost effective and equitable closure of issues and/or claims.
- Apply business unit policies, practices and procedures.
- Regularly interact with team members, TPA clients, or policyholders, brokers, legal counsel, physicians, nurses, rehabilitation consultants and injured workers to achieve individual and team goals.
- Identify and communicate trending and claims management practices that could impact the team’s book of business.
We’re looking for:
- Two to five years’ workers’ compensation claims adjusting experience.
- Bachelor Degree and Insurance designations are a plus.
- Previous TPA experience is desired.
- Demonstrated working knowledge of state applicable Workers’ Compensation Act and its application to claims administration.
- Demonstrate a working knowledge and skill in state regulatory reporting.
- Exceptional oral and written communication skills.
- Ability to assimilate, understand and analyze information from a variety of sources.
- Strong math and writing skills.
- Strong problem-solving and decision-making skills.
- Excellent computer skills (preferably in a Windows environment).
- Effective prioritization, organization and time management skills.
- Superior customer service and interpersonal skills.
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.
APPLY! Find out why SFM employees have stuck around for 30+ years!
SFM Mutual Insurance Company and each of its parent companies, subsidiaries and/or affiliated companies are Equal Opportunity/Affirmative Action Employers. All employment decisions are made without regard to race, color, religion, sex, national origin, age, sexual orientation, marital, familial, or veteran status, medical condition or disability, or any other legally protected classification. SFM Companies, EEO/AA Employers. SFM is a participant in E-Verify.