Workers Compensation Claims Representative
- Employer
- SFM Mutual Insurance Company
- Location
- Minneapolis, Minnesota
- Salary
- up to 75,000.00 DOQ
- Posted
- May 28, 2021
- Closes
- Jul 27, 2021
- Category
- Claims
- Job Type
- Full Time
- Career Level
- Entry Level
About SFM
Since 1983, our mission has been to be the workers’ compensation partner of choice for agents, employers and their workers. In that time we’ve expanded to over 20,000 customers in the Midwest and grown our offerings to include vocational rehabilitation, safe patient handling, loss prevention, medical services and more. 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.
Work somewhere you love
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. Find out why our employees rate us a top employer and choose to stay and grow with us.
As a Work Comp Claims Representative, you will manage an assigned caseload investigating and determining liability on claims of reported injury or occupational disease, and authorizing payment of medical and wage loss benefits. You will ensure accurate reserves are in place, and participate as an active team member of a multi-functional team. Experienced adjusters are encouraged to apply and will be consider for a higher-level position if qualified.
About SFM
Since 1983, our mission has been to be the workers’ compensation partner of choice for agents, employers and their workers. In that time we’ve expanded to over 20,000 customers in the Midwest and grown our offerings to include vocational rehabilitation, safe patient handling, loss prevention, medical services and more. 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.
The role
Investigates and manages claims in accordance with state workers’ compensation statutes, case law, client servicing instructions and Company best practices reflecting timely, customer-focused and cost effective case resolution. Works collaboratively with internal and external partners. Experienced adjusters are encouraged to apply and will be consider for a higher-level position if qualified.
What You Will Be Doing
- 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.
- 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.
- Authorizes payment of medical and wage loss benefits within payment authority.
- 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.
- If needed, attends field visits of policyholders, agents and injured workers, with assistance as needed. May include travel.
- 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.
- 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.
- 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.
- Identifies, analyzes and attempts to resolves payment changes and errors on files. When unable to resolve, actively seeks out and works with Claims Technical to learn for future application.
- Manages data timely and accurately on files to be in compliance with state regulatory reporting requirements, rating bureau reporting mandates and internal data needs.
Business Operations
- Demonstrates the skills to independently handle medical only and routine to moderately complex lost time claims. Seeks out assistance when claims do not resolve timely.
- Participates in discussions on file strategy.
- Assists less experienced representatives in claim management, use of company resources and company services.
- Shows professionalism to internal and external customers. Professionally works with other team members to best serve all customers of the team. This includes, but is not limited to, covering for other team members when they are absent, being respectful of others, and the ability to successfully resolve conflict. Constructively works with team members and others in the company when service and business improvement opportunities are identified.
- Shares thoughts and ideas in team meetings and encourages others to do the same. Demonstrates and promotes positive behavior and attitude among team members.
- Participates in projects when asked.
- Identifies and communicates trending and claims management practices that could impact the team’s book of business.
- Provides technical and marketing services in order to maintain agency and policyholder relationships so as to achieve success with new business goals, retention of renewals and loss experience consistent with team and company goals.
- Learns new jurisdictions when asked.
What We'll Love About You
- 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 skill in state regulatory reporting.
- 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, 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.