SECURA Insurance

  • Claims Representative - Workers' Compensation

    Location US-WI-Appleton
    Posted Date 3 weeks ago(4/4/2018 1:30 PM)
    Job ID
    2157
    Job Grade
    Grade 7
    Category
    Claims - Workers’ Compensation
  • Overview

    We are looking for a highly motivated nurse (RN) to combine in-house telephonic case management and claims representative duties. The position is responsible for managing assigned claims to ensure claims are managed to our Best Practices, including compensability review, appropriate treatment, and mitigating lost time, in a timely and cost-effective manner. Caseload may include catastrophic/complex medical/disability cases, lost time and/or medical only claims.

    Responsibilities

    • Develop medical management strategy and give the providers information necessary to facilitate an aggressive return-to-work plan.
    • Discuss cost-effective treatment alternatives when appropriate and ensure that injured workers have aggressive treatment plans in place.
    • Where appropriate, channel injured workers to network providers.
    • Analyze, review, negotiate, and settle Workers’ Compensation claims of varying complexity, in a thorough manner and with minimal supervision.
    • Control legal and medical bills/records to ensure savings for the company.
    • Make contact with injured workers and employers within 24 hours.
    • Work effectively with doctors, attorneys, insureds, injured employees, and associates.
    • Review and authorize reasonable and necessary medical treatment and associated diagnostic testing on assigned claims.
    • Participate in prehearing settlement conferences.
    • Establish and monitor reserves to adequately reflect the exposure, and make appropriate changes as each file develops.
    • Uphold highest level of service orientation toward all customers.
    • Assist in agency management by providing feedback to Underwriting.

    Qualifications

    ESSENTIAL:

    • Nursing degree, associates or bachelors.
    • Knowledge of medical terminology and the ability to interpret and understand medical records.
    • Exceptional computer and organizational skills.
    • Excellent verbal and written communication skills.
    • Ability to work independently.
    • Great problem-solving and decision-making skills.

    PREFERRED:

    • Advanced insurance courses such as AIC, CPCU, and CIC.
    • Two plus years’ of experience handling advanced Workers’ Compensation claims.
    • Knowledge of Workers’ Compensation laws.
    • Fluency in Spanish.

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