Claims Professional - Workers' Compensation

Workers’ Compensation Claims Representative Professional 

SFM – The Work Comp Experts

Work somewhere you love

Since 1983, our mission has been to be the workers’ compensation partner of choice for agents, employers and their workers.  SFM is unique in that we are small enough that your voice is heard, but has all the benefits and perks of a larger employer. We value your opinion, help you reach your goals, and make it easy for you to maintain work-life balance. Though much has changed through the years, our focus continues to be unrivaled customer service, safety, and providing better outcomes for employers and injured workers.  SFM is an employee centric organization, and we believe that your success is our success.  

Benefits include a flexible  work environment, health/dental insurance that includes supplemented dependent care coverage, generous PTO, student loan payback, a bonus program, 401k with match and much more!! Being able to work in a collaborative environment is key to being successful at SFM.  We believe that our exceptional and motivated employees are our greatest strength and we are committed to creating the best work environment to ensure your success. Apply today and discover why SFM employees choose to stay!! 

Our benefits include:

• Affordable Medical, Dental, Vision Insurance, HSA, FSA
• Traditional and Roth 401(k) plans with company match
• Company contributions to help pay off student loans
• Monthly home internet allowance
• Free life insurance, STD & LTD
• Opportunities for annual gainshare bonus 
• Pet insurance
• Generous PTO
• 9 paid holidays 
• Paid parental leave
• Annual company-wide volunteer day
• Adoption financial assistance

Visit our careers page to learn more about working at SFM.  

 The role

As a Claims Professional you will handle Workers’ Compensation claims for WI and MN.  The primary focus will be Minnesota claims for the assigned risk pool but you will also manage claims for Wisconsin. Using your experience handling workers' compensation claims, you will conduct investigations and manage claims in accordance with state workers’ compensation statutes, case law, and Company best practices. You will calculate lost wages and manage complex medical claims, and will handle the claim from start to finish.  This is a customer focused position and claims are handled so that a successful resolution is achieved for all parties. Working collaboratively in a multifunctional team is key to being successful in this role. The multi-functional team environment is what makes SFM different from other companies. You will find our systems are designed to help our Claims Reps handle claims efficiently because it was created for exclusively for work comp claims.  Experienced adjusters are encouraged to apply and will be considered for a higher level. Your job title and salary will be determined based on the experience you offer.  Expreince handling lost time claims is a must.  This is a work from home position, but applicants will need to live in MN, WI, or  IA.  Experienced work comp claims adjusters are encouraged to apply. 

Responsibilities 

1. Makes timely contact with all parties to a claim to gather necessary information to determine liability and fulfill regulatory, contractual, and internal reporting requirements. Applies the workers’ compensation statute and case law to facts to determine compensability. Uses internal resources as required by company best practices or client servicing instructions for questionable compensability decisions and subrogation or fraud issues. 
2. Sets expectations with the injured worker and employer of wellness, stay-at-work, or return-to-work, and importance of ongoing communication between all parties. Involve strategic business partners, to assist with return-to-work or stay-at-work.
3. Authorizes payment of medical and wage loss benefits within payment authority.
4. Assigns, directs, and manages medical, rehabilitation and legal services pursuant to the respective business’s procedures, client service instruction and applicant state law. This includes documentation in claim comments of facts, issues and plans.
5. If needed, attends field visits of policyholders, agents and injured workers, with assistance as needed. May include travel.
6. Establishes initial and ongoing case reserves within authority level that accurately reflect file exposure in accordance with Company best practices and client reserving guidelines relating to qualitative analysis and timing. Recommends reserves for cases that exceed authority level. 
7. Communicates and educates the employer on case exposure/reserves and how to mitigate the exposure. Communicates and partners with the reinsurer regarding case exposure/reserves, high expense items and issues which impact future costs.
8. Provides and documents strategy to bring cases to resolution per SFM best practices, procedures and philosophy. This is evidenced by documenting files in claim comments with 1) timely action plans; 2) pertinent facts and issues for roundtable discussions; and 3) analysis of settlement exposure, including, with assistance, the use of spreadsheets.

We’re looking for

• Bachelor’s degree preferred.
• Six months or more of workers compensation lost time experience
• Knowledgeable of state applicable Workers’ Compensation Act and its application to claims administration.
• Knowledge and skills in state regulatory reporting.
• Strong knowledge of medical terminology, anatomy and procedures.
• Understanding of insurance finance.
• Excellent customer service and interpersonal skills.
• Good oral and written communication skills.
• Ability to effectively interact with a diverse group of customers and business units.
• Ability to assimilate, understand and analyze information from a variety of sources.
• Strong math skills.
• Developing skills in investigating, negotiating and settling claims.
• Problem-solving and decision-making skills.
• Acts as a mentor to others when requested.
• Strong computer skills (preferably in a Windows environment.)
• Effective prioritization, organization and time management skills.
• Demonstrates positive teaming skills focused on team results.

Physical Requirements 

Regular attendance is required. Work takes place in a semi paperless environment within an office setting, either on business premises or other remote location, using standard office equipment such as computers, phones, and photocopiers, 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, and maintain concentration and focus. 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.

 Join us 

Watch videos to learn more about SFM’s careers and culture.

 https://www.youtube.com/watch?v=g7VkUazIOXA

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.