Workers' Comp Claim Representative I - TN

Summary: Emergent Holdings is seeking an entry level professional claim handler. The role involves handling medical only and indemnity benefits, determining compensability of claims, and negotiating settlements within given authority. Responsibilities: - Verifies workers’ compensation coverage of employers and injured employees - Determines compensability under workers’ compensation by thorough investigation of the claim - Determines causal relationship between the reported injury and the incident to ensure appropriate payment of benefits - Facilitates return to work for the injured employee - Establishes timely and appropriate reserves based on the profile of the claim within given authority based on anticipated financial exposure - Documents specifics of claims with potential for subrogation recovery, including amount of potential recovery monies - Manages medical bills for non-indemnity and indemnity claims directly associated with the claimed injury. Approves payment based on knowledge of the treatment plan and medical support showing relationship of treatment to the injury - Concludes and closes files following resolution of claims to meet internal performance standards while complying with state legislation to avoid penalties and manage expenses - Negotiates settlements with attorneys or injured parties within given authority at the earliest possible point to bring cases to final disposition - Works closely with manager on complex files or files above settlement/reserve authority - Manages outside vendors to ensure cost containment efforts - Establishes and maintains effective working relationships with all internal and external customers - Stays abreast of changes in workers’ compensation statutes, case law and rehabilitation efforts/advancements in order to accurately interpret and apply relevant laws Required Qualifications: - Bachelor's degree in a related field - One (1) year relevant experience that provides the necessary skills, knowledge and abilities or completion of claims trainee program - Ability and proficiency in the use of computers and company standard software specific to position - Knowledge of medical and legal terminology related to the work - Knowledge of workers' compensation laws and regulations, including jurisdictional laws - Effective oral and written communication skills - Effective customer service skills - Ability to negotiate, build consensus and resolve conflict - Ability to manage multiple priorities and meet established deadlines - Attention to detail and analytical skills - Ability to work independently as well as within a team Preferred Qualifications: - Certification or progress toward certification is highly preferred and encouraged - Bilingual skills preferred Required Skills: Workers’ compensation laws, regulations, Medical terminology, Legal terminology, Claims processing, Use of computers, company standard software, Bilingual skills, Customer service, Consensus building, Analytical skills, work within a team, manage multiple priorities, Meeting deadlines, Effective oral communication, Effective written communication