Sr. Claims Representative (WC)

About Acrisure:

Acrisure is a global Fintech leader that combines the best of humans and high tech to offer multiple financial products and services to millions of businesses and individual clients. We connect clients to solutions that help them protect and grow what matters, including Insurance, Reinsurance, Cyber Services, Mortgage Origination and more.

Acrisure employs over 17,000 entrepreneurial colleagues in 21 countries and have grown from $38 million to $4.3 billion in revenue in just over ten years. Our culture is defined by our entrepreneurial spirit and all that comes with it: innovation, client centricity and an indomitable will to win.

Job Summary:

Responsible for managing workers’ compensation claims as assigned by claims supervisor. Investigates claims. Determines the compensability of the claim and extent of liability. Communicates directly with clients, employers, injured workers, physicians, and attorneys to bring claims to a timely conclusion.

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).

Additional Responsibilities:                                                                                                                                        

• Presents information, alongside the client(s), on organizational services to prospective client members

• Provides guidance for and mentors less experienced co-workers to develop understanding of procedures, applicable laws and improve their handling abilities.

• Attends seminars and meetings as needed to stay abreast of current industry knowledge.

• Coordinates periodic adjuster training & educational sessions at the direction of claims supervisor.

• May attend mediations, hearings, trials or other legal proceedings.

• Other duties may be assigned.

Qualifications:

• A High School Diploma or eq