Claims Representative

  • Location

    Egg Harbor, United States

  • Sector:

    Other Area(s)

  • Job type:


  • Contact:

    Leric Arcigal

  • Job ref:


  • Published:

    over 1 year ago

  • Expiry date:


Positions is for an Adjuster.

Under close supervision, investigates, adjusts and pays lost time Workers Compensation claims in a timely manner in accordance with legal statutes, policy provisions and company guidelines.

KEY RESPONSIBILITIES: (Duties may include, but are not limited to all or some of the following)

Review, investigate and analyze Workers Compensation claims. Interact with injured employees to ensure awareness and understanding of the Workers Compensation process, requirements and entitlements. Establish claim reserve levels by estimating the cost of each assigned claim, monitor reserves and update amounts as necessary. Establish compensability status through case investigation and evaluations and application of jurisdictional status and laws. Oversee and coordinate medical treatment for injured employees and provide information to treating physicians regarding employees medical history, health issues, and job requirements; provide direction to assigned nurse case manager where applicable. Identify subrogation potential and pursue the process of reimbursement. Attend and participate in staff meetings and keep supervisor informed of status on all assigned cases and plan of action. Stay abreast of new trends, pending legislation and case law related to workers compensation. Process PARs (payment authorization request) and CARs (claim analysis report) when applicable. Assign to a field investigator for GOTCHA visitation within the account specific timeframe. Manage self-insured retention excess reporting. Routinely interact with clients, claimants, attorneys, investigators, experts and other vendors. Perform other duties as required. Manage diary and complete tasks to ensure that cases move to the best financial outcome and timely resolution. Close all files as appropriate in a timely and complete manner. Maintain closing ratio as directed by management team.