Responsibilities
- Adjudicate and investigate workers' compensation claims.
- Manage all technical aspects of claim handling for assigned cases, including adherence to performance guidelines.
- Investigate and handle various workers' compensation file types, such as lost time, litigation, and long-term exposure, within set guidelines.
- Initiate return-to-work discussions with employers and facilitate the injured worker's return to work.
- Set timely and appropriate case reserves.
- Investigate and manage subrogation and negotiate settlements.
- Use an automated diary system to issue indemnity benefits and manage claims.
- Accurately calculate and disburse wage loss and other benefits.
- Assign rehabilitation and monitor associated costs and outcomes.
- Document all action plans and evaluations for claim resolution.
- Maintain organized electronic files.
- Interact with clients to establish and improve communication and service capabilities.
- Communicate with state agencies, attorneys, and other providers.
- Address customer complaints and inquiries in a professional manner.
- Achieve specific performance outcomes related to work quality and quantity as set by management.
- Contain costs for individual claims and overall account claims to ensure account profitability.
- Define medical and rehabilitation payment parameters for staff.
- Perform other functions as assigned.