Claims Representative-Workers Compensation

Drive successful WC claim outcomes through smart investigation, clear communication, and proactive management of treatment and return to work This role will be staffed in our Richmond, VA office following the hybrid work model. This role is NOT available for remote work. Based on experience and qualifications, the pay range for this position is $68,100-$102,100 annually. What You'll Do As a Claims Rep-WC, you will: Provide all aspects of customer service with empathy and understanding by assisting customers through difficult situations. You're the primary point of contact between the injured employee, health care providers and employers. Maintain active communication with all parties involved to gather information and provide updates on the status of claims. Verify coverage, compensability and investigate causation by gathering pertinent information. Conduct thorough investigations into the circumstances surrounding the injury or illness. This may involve reviewing medical records, interviewing involved parties, and examining workplace conditions including job descriptions. Assess the extent of the employee's injury or illness to determine the benefits they are entitled to receive under workers' compensation (WC) laws. This may include medical treatment and disability payments. Effectively manage and develop action plans to move files toward resolution. Calculate benefits, evaluate, and approve payments to medical providers, suppliers, and the injured employee. Collaborate with employers, health care professionals and case managers to facilitate the injured employee's return to work in a safe and timely manner, which may involve modified duty assignments or accommodation. Accurately document all aspects of the claim, including investigation details, injury reports, medical records and correspondence with any involved parties. Additionally, you will: Ensure compliance with regulations governing WC claims, including reporting requirements, deadlines, and file coding as defined by the state. Collaborate with the special investigation unit, as necessary to investigate and mitigate- fraud Perform other job-related duties as assigned from time to time. What it Takes Obtain and maintain state adjuster licensing as applicable Bachelors Degree or equivalent work experience Minimum 1 year of related work experience Insurance experience and/or coursework preferred Ability to review and analyze detailed documents, insurance policies, coverages, medical terminology, and insurance regulations Confidence when making appropriate claim decisions, prioritizing, and managing workload Effective verbal and written communication skills What You'll Receive At Sentry, your total rewards go beyond competitive compensation. Below are some benefits and perks that you'll receive. Sentry is happy to offer flexibility through a scheduled Hybrid work model. Monday and Friday work from home if you choose to, Tuesday through Thursday you'll work in office. As a Sentry associate, you will have an in-office workspace and materials for your home office. In addition to the laptop, you will receive prior to your start, Sentry will provide equipment for your home office. Meal Subsidy available for associates who report to an office. 401(K) plan with a dollar for dollar match on your first eight percent, plus immediate vesting to help strengthen your financial future. Continue your education and career development through Sentry University (SentryU) and utilize our Tuition Reimbursement program Generous Paid-Time Off plan for you to enjoy time out of the office as well as Volunteer-Time off Group Medical, Dental, Vision, Life insurance, Parental leave, and our Health and Wellness benefits to encourage a healthy lifestyle. Well-being and Employee Assistance programs Sentry Foundation gift matching program to encourage charitable giving. About Sentry We take great pride in making Forbes' list of America's Best Midsize Employers. A lot of different factors go into that honor, many of which contribute to your job satisfaction. Our bright future is built on a long track record of success. We got our start in 1904 and have been helping businesses succeed and protect their futures ever since. Because of the trust placed in us, we're one of the largest and financially strongest mutual insurance companies in the United States. We're rated A+ by A.M. Best, the industry's leading rating authority. Our headquarters is in Stevens Point, Wisconsin, with offices located throughout the United States. From sales to claims, and information technology to marketing, we enjoy a rewarding and challenging work environment with opportunities for ongoing professional development and growth. Get ready to own your future at Sentry. Opportunities await! Talent Acquisition Specialist Shea Supa Equal Employment Opportunity Sentry is an Equal Opportunity Employer. It is our policy that there be no discrimination in employment based on race, color, national origin, religion, sex, disability, age, marital status, or sexual orientation. Our associates are the most important part of our company. We became one of the most financially strong mutual insurance companies in the U.S. by striving to provide the best possible service to our business customers. We do this by having conversations, forming relationships, and getting to know the people we work with and their businesses. We make that same commitment to our associates. When you join Sentry, we don't just want you to perform tasks each day. We want you to enjoy your time with us. You're in the driver's seat of your career path here—sharing feedback, creating goals, accessing professional development resources, and identifying how you can contribute to both your success and the success of the company. Yes, we work hard. But we work with the purpose of helping others, and with the understanding that there's more to life than work. We invite you to learn more about us. You'll find we're much more than insurance.