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Workers' Compensation Claims Representative - Inside

:
2020-2148
:
1
:
US-IA-Cedar Rapids
:
1/9/2020
:
Claims
:
None
No
 
 

Overview:

UFG offers you an award-winning workplace and a trustworthy, financially stable company. While we’ve always known our commitment to employees and financial stewardship, it is good to have others recognize our dedicated efforts. We've been named an Iowa Top Workplace by the Des Moines Register for four consecutive years, and included on Forbes’ “America’s Most Trustworthy Financial Companies” every year since 2014. Additionally, UFG is a super-regional property and casualty insurer rated “A” (Excellent) by A.M. Best Company.

 

The Workers' Compensation Claims Rep will review and process workers compensation claims within reserve authority;  Determine by investigation if a claim is compensable, reviewing coverages, establishing and maintaining adequate reserves while Informing, notifying and educating agents, marketing representatives, other departments and state agencies of decisions and results. They will also file required state workers compensation reports.

Responsibilities:
  • Review assignments to determine the nature of the claim and action required as well as coverages involved. Initial contact with claimant within 24 hours on serious cases.
  • Conduct telephone interviews, taking recorded statements from insureds, claimants, witnesses and others possessing facts concerning the claim. Contact any other person(s) having knowledge of the incident.  Interview injured persons to determine extent and severity of potential loss
  • Review and interpret to determine whether the claim is payable under the applicable workers compensation statute.
  • Recommend reserves to supervisor or make necessary reserve changes within your authority.
  • Use data gathered to evaluate and process payments for medical compensation benefits
  • Write reports for the claim file to document all activity relating to the loss. Inform underwriting if increased hazards or unusual circumstances concerning a risk/policy exposure. 
  • Maintain necessary records for reference and diaries.
  • Answer phone inquiries from agents, insureds or claimants.
  • Compile and review information concerning losses from various sources including medical records, physician’s reports and wage information. Contact physicians, therapists, attorneys or others to obtain reports, bills or other information.  Determine extent of injury or possible malingering of claimants. 
  • Determine/evaluate damages. Evaluate information gathered to determine the dollar amount of the loss.
  • Follow consistent reserve practices in recommending reserves on supervised files or setting reserves on self-supervised files to achieve the company guideline of overall reserve redundancy.
  • Timely identify claims where lost time may be a factor and seek supervisor input.
  • Contact claimants to explain and negotiate settlements. Obtain releases and issue drafts.
  • When applicable, actively pursue subrogation claims with the insurance carrier or uninsured wrongdoer to recover funds due the company. Refer to subrogation unit to pursue collection.
  • Keep up to date concerning recent court cases, changes in the law, and new medical techniques.
  • Promotes positive working relationships with agents in the territory by keeping the producing agent informed of progress on claims.
  • Participate in company sponsored educational programs to develop and maintain knowledge of products, procedures and industry trends.
  • Attend state sponsored workers compensation meetings.
  • Respond to agent status requests and handle routine telephone inquiries from others including, but not limited to claimants, insured, and agents.
  • File required state reports through EDI reporting or paper reporting. Make phone contact with insured to obtain additional information not contained on the reports but required for EDI reporting. 
  • Complete the DCI file detail reporting call.

Qualifications:

Education:

  • High school diploma required. 
  • Four year college degree preferred
  • WCLA designation or ability to complete within two years of employment.

Experience:

  • 1+ years of medical/health experience or other insurance or insurance related experience plus

Knowledge, skills & abilities:

  • Basic understanding of coverage and transaction codes to make corrections.
  • Must be able to comprehend and visualize accident scenes, injury scenarios and other similar situations by telephone contact and fact finding interviews.
  • Must have the ability to know when the request is appropriate and be able to express in clear terms the exact assistance needed.
  • Ability to read, comprehend and interpret applicable statute and apply to loss. Have analytical ability to determine reserves.  Understand technical aspects of equipment used.
  • Know and understand medical terminology, read and interpret hospital and nursing records and physicians reports. Relate impairment ratings to statute for compensation awards.
  • Must possess human relations skills, analytical skills, organization skills as well as oral and written communication skills.
  • Ability to understand legal issues relating to duties and impact of court decisions on day-to-day handling of claims.
  • Ability to communicate with agents concerning the status of claims regardless of status (paid, denied, compromised).
  • Must possess the ability to manage time and resources in order to find study time.

Working Conditions:

  • General office environment


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Equal Opportunity Employer

UFG is an equal opportunity employer. All qualified applicants will receive consideration and will not be discriminated against on the basis of race, gender, sexual orientation, gender identity, disability, protected veteran or any other protected status. If you need a reasonable accommodation for any part of the employment process, please email humanresource@unitedfiregroup.com to provide the nature of your request. Only inquires for an accommodation will be responded to. For more information on rights protecting job applicants, click here: Equal Employment Opportunity (EEO), Employee Polygraph Protection Act (EPPA), Family and Medical Leave Act (FMLA).

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