Sr. Claims Representative

Essential Duties and Responsibilities include the following. Other duties may be assigned: 

• Interviews, telephones, or corresponds with claimant and witnesses, consults police and hospital records.
• Contacts physicians to obtain medical diagnoses and projected treatment plans.
• Monitors medical progress of claimants and coordinates follow-up treatments; reports to employers including any restrictions that may be imposed on claimants’ return to work.
• Documents all information from contacts with employers, claimants, physicians, and attorneys into the claims’ management system and ensures that documentation is current.
• Calculates and sets reserves through a reserve worksheet including the nature and scope of claims; adjusts reserves to reflect ultimate known exposures.
• Issues medical, indemnity, legal and expense payments
• Prepares reports for excess carriers and requests reimbursement when needed.
• Sets reminders to follow-up on tasks through diaries on the system; reviews and completes diaries daily.
• Maintains physical files for claim-related documents such as medical information, legal reports, and other correspondence.
• Calculates and issues indemnity benefits such as temporary total disability (TTD) and permanent disability in a timely manner and in accordance with applicable state laws.
• Assigns case managers or vocational rehabilitation counselors, as necessary.
• Reviews claims’ information from ISO ( Index Bureau)
• Conduct on-site investigation of claims if circumstances require it.
• Determine necessity of legal defense, coordinates, and monitors litigation with attorneys.
• Reviews claims’ submissions for thoroughness and accuracy.
• Determines compensability of claims through information gathered and according to workers’ compensation statutes; makes recommendations as to compensability and coverage of claims.
• Processes medical-only worker’s compensation claims involving minor injuries and /or payment
• Provides guidance and advice to clients on direction of claims after all information has been gathered and analyzed.
• Ensures jurisdictional filings are complete and timely.
• Obtains pre-certification approval for specific treatments as needed.
• Prepares reports every 90 days, or as requested, for excess carriers regarding cases with catastrophic injuries; requests recoveries and follows up for receipt of monies.
• Reviews bills and medical notes; authorizes and codes bills.
• Prepares periodic written file reviews and attends meetings for specific clients to discuss claims’ statuses, current reserves, litigation statuses (if any) and future action plans outlined by contracts or requested by client(s).

Acrisure is committed to employing a diverse workforce. All applicants will be considered for employment without attention to race, color, religion, age, sex, sexual orientation, gender identity, national origin, veteran, or disability status.  California residents can learn more about our privacy practices for applicants by visiting the Acrisure California Applicant Privacy Policy available at www.Acrisure.com/privacy/caapplicant.
 

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