Investigate, evaluate and independently manage all types of workers’ compensation claims to ensure prompt, fair, and accurate resolution to achieve KEMI’s strategy and objectives.
Investigate claims and determine compensability in accordance with applicable statute, case law and experience.
Ensure medical treatment is work related and is medically reasonable and appropriate.
Manage claims through well-developed action plans to bring the claims to an appropriate and timely resolution.
Accurately calculate the injured workers’ average weekly wage and initiate indemnity benefits to ensure that injured workers are paid timely and accurately.
Establish and maintain appropriate reserves in accordance with departmental policies and procedures.
Communicate with attorneys to resolve areas of dispute and negotiate appropriate and timely settlements.
Actively manage the litigation process; ensure timely and cost-effective claim resolution.
Provide quality customer service by promptly responding to both internal and external questions or requests, educating injured workers and customers, and to assist in policyholder retention efforts.
Prepare timely and appropriate file reviews, per departmental guidelines.
Interact directly with policyholders on claim updates and resolution strategies.
Achieve employee SMART Goals.
Perform other duties as requested.
Knowledge, Skills and Abilities:
Strong organizational skills and attention to detail.
Ability to manage claims independently.
Proficient claims knowledge in indemnity claims.
Knowledge of medical terminology.
Strong analytical and sound decision making skills.
Effective communication skills, both written and oral.
Intermediate knowledge of Microsoft Word, Excel and Outlook.
Ability to learn custom software programs.
Bachelor’s Degree or licensed Registered Nurse preferred.
Four years progressive insurance experience and AIC designation preferred.
Adjuster’s License and ODG certification required.
Efficiently i nvestigate, evaluate, and independently manage all types of workers’ compensation claims.
Ability to sit at a desk for extended periods of time, answer the telephone, operate a computer, keyboard and mouse throughout the day and occasionally walk.
Adhere to all company policies.
Ability to interact professionally with coworkers, customers, vendors and medical providers.
Actively support the KEMI Mission, Vision, Values and culture.
The requirements listed above are representative of the knowledge, skills and/or abilities required to perform each essential duty satisfactorily. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.