Workers Compensation Claims Representative Position Available In Charleston, South Carolina
Tallo's Job Summary: The Workers Compensation Claims Representative analyzes and manages complex claims, negotiates settlements, calculates benefits, and ensures timely resolution. They coordinate vendor referrals, communicate with clients, and maintain claim documentation. This role involves assessing liability, managing litigation, and adhering to industry best practices. The position requires attention to detail and strong communication skills.
Job Description
Job Description:
Workers Compensation Claims Representative
PRIMARY PURPOSE
To analyze complex or technically difficult claimsto determine benefits due; to work with high exposure claimsinvolving litigation and rehabilitation; to ensure ongoingadjudication of claims within service expectations, industry bestpractices and specific client service requirements; and to identifysubrogation of claims and negotiate settlements.
ESSENTIAL
FUNCTIONS and
RESPONSIBILITIES
?Analyzes and manages complex or technically difficult claims byinvestigating and gathering information to determine the exposureon the claim; manages claims through well-developed action plans toan appropriate and timely resolution. ?Assesses liability and resolves claims within evaluation. ?Negotiates settlement of claims within designated authority. ?Calculates and assigns timely and appropriate reserves to claims;manages reserve adequacy throughout the life of the claim. ?Calculates and pays benefits due; approves and makes timely claimpayments and adjustments; and settles clams within designatedauthority level. ?Prepares necessary state fillings within statutory limits. ?Manages the litigation process; ensures timely and cost effectiveclaims resolution. ?Coordinates vendor referrals for additional investigation and/orlitigation management. partnerships to reduce overall cost of claims for our clients. ?Reports claims to the excess carrier; responds to requests ofdirections in a professional and timely manner. ?Communicates claim activity and processing with the claimant andthe client; maintains professional client relationships. ?Ensures claim files are properly documented and claims coding iscorrect. ?Refers cases as appropriate to supervisor and management. We are an equal employment opportunity employer and will considerall qualified candidates without regard to disability or protectedveteran status.
