Workers' Compensation Claim Representative II
$60,000–$72,000 year
HybridReno, Nevada, United States
Job Summary
Investigate and adjust workers compensation claims using CCMSI guidelines, reviewing medical, legal, and miscellaneous invoices to determine reasonableness and negotiate disputed bills. Authorize claim payments within settlement authority and negotiate settlements with claimants and attorneys per client authorization. Assist in selecting and supervising defense attorneys while assessing and monitoring subrogation claims for resolution. Prepare reports detailing claims, payments, and reserves, and monitor files as required by excess insurers. Maintain compliance with service commitments and deliver quality claim service to clients. This role requires a Nevada Adjuster's License and 5+ years of claims management experience.
Required Qualifications
- 5+ years of Workers' Compensation claims management experience, or an equivalent combination of education and experience.
- Current Nevada Adjuster's License
- Strong organizational, prioritization, and multitasking skills with the ability to work independently.
- Excellent verbal and written communication skills.
- Ability to maintain confidentiality and exercise sound judgment.
- Proven ability to thrive in a fast-paced, changing environment and work effectively as part of a team.
- Customer-focused with a commitment to responsive service.
- Proficiency in Microsoft Office Suite (Word, Excel, Outlook).
Desired Qualifications
- Associate degree
- Experience handling multiple accounts of various industries.
- Bilingual (Spanish) proficiency
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