Medical-Only Claim Representative-Workers' Compensation

Medical Only Claim Representative - Remote - Must live in Wisconsin to be considered 

SFM – The Work Comp Experts

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. SFM is committed to creating the best work environment and believes that our exceptional and motivated employees are our greatest strength. SFM emphasizes work life balance, and our benefit package is designed to assist you navigate your work-life journey. 

Our benefits include:

• Affordable Medical, Dental, Vision Insurance, HSA, FSA
• Traditional and Roth 401(k) plans with company match
• Company contributions to help pay off student loans
• Monthly home internet allowance
• Free life insurance, STD & LTD
• Opportunities for annual gainshare bonus 
• Pet insurance
• Generous PTO
• 9 paid holidays 
• Paid parental leave
• Annual company-wide volunteer day
• Discounts on gym memberships, fitness apps and weight loss programs
• Adoption financial assistance

  Visit our careers page to learn more about working at SFM.  

The role 

At SFM, the Medical Only Claims Representative investigates workers' compensation claims to assess whether medical treatment for injured workers is compensable. SFM is committed to providing you the training you need to be successful in this role and will help you develop your skills to grow professionally.  This position is a great way to jump start your career at SFM and learn the ins-and-outs of claims handling.  In this position, you will work with employees, employers, and medical providers to pay medical benefits according to the State's guidelines and SFM’s best practices with the goal to provide a successful resolution of a workers' compensation claim. Using your strong communication skills and critical thinking skills, you will focus on delivering excellent customer service to all parties involved in the claims process.  Working  collaboratively within a multifunctional team is what makes SFM unique and creates a strong team setting.  SFM  offers a work environment designed to support flexibility and our benefit options are fashioned so you area able to manage your work-life journey and can bring the best version of yourself to work each day!! Applicants must live in Wisconsin to be eligible for this job. 

What You Will Be Doing

• Manages medical-only claims files as assigned by setting up new losses, setting future tasks, requesting medical records and itemized statements, making contact with the policyholder and injured worker and entering necessary file comments into the database. Determines and explains coverage. Works with EEs, physicians, nurses, attorneys within a multifunctional team environment.
• Approves medical bills that correspond with files, which includes verifying adequate reserves, reviewing for compensability and application of any applicable treatment parameters. May negotiate settlements.
• Identifies subrogation or fraud  opportunities and refers claim to SIU department for follow-up.
• Makes use of company resources to maintain and control costs.
• Uses foresight and recognizes the need to consult with or transfer claims back to lost time claims representative if claim is expected to exceed reserve limits, involve a claim for indemnity benefits or involve disputes unable to be resolved.
• Takes advantage of learning opportunities to develop, update and expand skills, knowledge and abilities, and applies learning. Keeps apprised of workers’ compensation rules and regulations and company best practices.
• Regularly interacts with team members, policyholders, agents, legal counsel, physicians, nurses, and injured workers to achieve individual team goals. Maintains appropriate interactions with both internal and external customers
• Identifies and communicates trending and claims management practices that could impact the team’s book of business from both an MO perspective and overall team perspective.
• Proactively manages claim inventory to ensure all assigned claims are handled to completion in a timely fashion, including follow-up contacts, bill payment, etc., compliant with regulatory requirements

What We'll Love About You

• Associate’s degree or two years’ business experience, preferably in an insurance environment or medical office.
• One or more years handling casualty claims, PIP claims or workers’ compensation claims, preferred.
• Ability to maintain confidentiality.
• Must be detailed oriented.
• Excellent customer service skills, and the ability to work well within a team environment.
• Excellent problem solving and decision making skills.
• Strong verbal and written communication skills.
• Ability to conduct research, assimilate and interpret complex information from a variety of sources.
• Ability to work in a fast paced environment and manage multiple projects and deadlines with limited supervision.
• Effective conflict resolution skills.
• Basic mathematic skills.
• Proficient in MS Office software applications (Excel/Word, etc.).

Work Environment and Physical Demands

Work takes place in a remote semi paperless environment within a home office setting or in-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.  Regular attendance is required. 

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 25,000 customers in the Midwest and grown our offerings to include vocational rehabilitation, 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.

Join us!! Click Apply Now 

Watch Videos to learn more about SFM’s careers and culture.

 SFM Mutual Insurance Company and each of its parent companies, subsidiaries and/or affiliated companies are Equal Opportunity/Affirmative Action Employers. SFM provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, status with regard to public assistance, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

 SFM Companies, EEO/AA Employers. SFM is a participant of E-Verify. Applicants have rights under Federal Employment Laws.