As a Claims Rep-WC, you will: Provide all aspects of customer service with empathy and understanding by assisting customers through difficult situations. You’re the primary point of contact between the injured employee, health care providers and employers. Maintain active communication with all parties involved to gather information and provide updates on the status of claims. Verify coverage, compensability and investigate causation by gathering pertinent information. Conduct thorough investigations into the circumstances surrounding the injury or illness. This may involve reviewing medical records, interviewing involved parties, and examining workplace conditions including job descriptions. Assess the extent of the employee’s injury or illness to determine the benefits they are entitled to receive under workers’ compensation (WC) laws. This may include medical treatment and disability payments. Effectively manage and develop action plans to move files toward resolution. Calculate benefits, evaluate, and approve payments to medical providers, suppliers, and the injured employee. Collaborate with employers, health care professionals and case managers to facilitate the injured employee’s return to work in a safe and timely manner, which may involve modified duty assignments or accommodation. Accurately document all aspects of the claim, including investigation details, injury reports, medical records and correspondence with any involved parties. Additionally, you will: Ensure compliance with regulations governing WC claims, including reporting requirements, deadlines, and file coding as defined by the state. Collaborate with the special investigation unit, as necessary to investigate and mitigate- fraud Perform other job-related duties as assigned from time to time. What it Takes Obtain and maintain state adjuster licensing as applicable Bachelors Degree or equivalent work experience Minimum 1 year of related work experience Insurance experience and/or coursework preferred Ability to review and analyze detailed documents, insurance policies, coverages, medical terminology, and insurance regulations Confidence when making appropriate claim decisions, prioritizing, and managing workload Effective verbal and written communication skills