SUMMARY:

Investigates, evaluates and concludes claims of simple to medium complexity. Typically handles medical only and non-complex indemnity claims. This position is the introductory level of the claims representative career path. A State of Michigan Resident Insurance Adjuster License is to be obtained within one year of hire.

EMPLOYMENT QUALIFICATIONS EDUCATION OR EQUIVALENT EXPERIENCE:

Associate degree in related field required. Bachelor’s degree preferred. The relevant combination of education and experience may be considered in lieu of a degree. Continuous learning, as defined by the Company’s learning philosophy, is required. Certification or progress toward certification is highly preferred and encouraged.

EXPERIENCE:

With proper education credentials, no experience required; however, one year of relevant experience that provides the necessary skills, knowledge and abilities, such as experience in an insurance environment, is preferred. Bilingual skills preferred.

SKILLS/KNOWLEDGE/ABILITIES (SKA) REQUIRED:

• Ability and proficiency in the use of computers and company standard software specific to position.
• Effective oral and written communication skills.

• Effective customer service skills.

• Ability to manage multiple priorities and meet established deadlines.
• Knowledge of medical and legal terminology.

• Knowledge of workers’ compensation laws.

• Ability to perform basic math calculations.

• Attention to detail and analytical skills.

WORKING CONDITIONS:

The qualifications listed above are intended to represent the minimum education, experience, skills, knowledge and ability levels associated with performing the duties and responsibilities contained in this job description.

• Verifies workers’ compensation coverage of employers and injured employees.

• Investigates claims to determine causal relationship between employee injuries and work-related accidents or activities.
• Determines compensability of workers’ compensation claims and establishes required reserves within authority.
• Reviews medical treatment plans and computes medical bills for non-indemnity and simple indemnity claims directly associated with work-related accidents or activities.
• Ensures that all payments are made in an accurate and timely manner and that all files are closed to meet internal performance standards while complying with state legislation to avoid penalties and reduce the amount of supplemental bills.
• Stays abreast of changes in workers’ compensation laws.
• Completes other duties and special projects as requested. This position description identifies the responsibilities and tasks typically associated with the performance of the position. Other relevant essential functions may be required.