Vacancy caducado!
Sunrise System Inc. is currently looking for
Claims Representative-Workers Compensation in Southfield, MI with one of our top client. Job Title: Claims Representative-Workers Compensation Job Id: 21-07121Location: 20700 Civic Center Drive, Suite 400, Southfield, MI 48076( Hybrid Schedule-3 days in office 2 days WFH)Duration: 6 months Temp to PermPosition Type: Hourly contract Position (W2 only) Summary- Under the direction of the Claims Team Leader investigates and settles claims promptly, equitably and within established best practices guidelines.
- Receive assignments.
- Reviews claim and policy information to provide background for investigation and may determine the extent of the policy’s obligation to the insured depending on the line of business.
- Contacts, interviews and obtains statements (recorded) from insureds, claimants, witnesses, physicians, attorneys, police officers, etc. to secure necessary claim information.
- Evaluates facts supplied by investigation to determine extent of liability of the insured, if any, and extend of the company’s obligation to the insured under the policy contract.
- Prepares reports on investigation, settlements, denials of claims, individual evaluation of involved parties etc.
- Sets reserves within authority limits and recommends reserve changes to Team Leader.
- Reviews progress and status of claims with Team Leader and discusses problems and suggested remedial actions.
- Prepares and submits to Team Leader unusual or possible undesirable exposures.
- Assists Team Leader in developing methods and improvements for handling claims.
- Settles claims promptly and equitably.
- Obtains releases, proofs of loss or compensation agreements and issues company drafts in payments for claims.
- Informs claimants, insureds/customers or attorney of denial of claim when applicable.
- May assist Team Leader and company attorneys in preparing cases for trial by arranging for attendance of witnesses and taking statements. Continues efforts to settle claims before trial.
- Refers claims to subrogation as appropriate. May arrange for other recovery proceedings as necessary by line of business.
- May participate in claim file reviews and audits with customer/insured and broker.
- Administers benefits timely and appropriately. Maintains control of claim’s resolution process to minimize current exposure and future risks
- Establishes and maintains strong customer relations
- Depending on the line of business, other duties may include:
- Maintaining system logs
- Investigating compensability and benefit entitlement
- Reviewing and approving medical bill payments
- Managing vocational rehabilitation
- 1-2 years experience handling claims in a relevant line of business would be a plus!
- Basic knowledge of claims handling and familiarity with claims terminologies
- Strong communication and interpersonal skills to be capable of dealing with claimants, customers, insureds, brokers, attorneys etc in a positive manner concerning losses.
- Ability to self motivate and work independently
Vacancy caducado!