Worker's Compensation Claim Representative
*Must Currently Live in Indiana*
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
- Adoption financial assistance
Visit our careers page to learn more about working at SFM.
The role
As an experienced Sr. Workers' Compensation Claims Rep, who lives in Indiana, you will Investigate and manage claims in accordance with state workers’ compensation statutes, case law, and Company best practices. This new, fully remote position supports SFM’s expansion into Indiana. You will calculate lost wages and manage more complex medical claims and assist the injured worker and employer in the claim process.
Customer focus and successful resolutions are at the heart of this role, and you'll thrive by working closely with our multifunctional team. This remote position is perfect if you're in Indiana and looking for a role that combines expertise with teamwork. Make a difference with SFM and experience a supportive and collaborative work environment!
What You'll Do:
Claims Management
- Makes timely contact with all parties to a claim to gather necessary information to determine liability and fulfill regulatory, contractual and internal reporting requirements. Applies the workers’ compensation statute and case law to facts to determine compensability. Uses internal resources as required by company best practices or client servicing instructions for questionable compensability decisions and subrogation or fraud issues.
- Sets expectations with the injured worker and employer of wellness, stay-at-work, or return-to-work, and importance of ongoing communication between all parties. Proactively involves strategic business partners as needed, such as, legal, rehab services, case managers to assist with return-to-work or stay-at-work.
- Authorizes payment of medical and wage loss benefits within payment authority.
- Assigns, directs, and manages medical, rehabilitation, investigative and legal services pursuant to the respective business procedures, and or client service instructions and applicable state law. This includes clear documentation in claim comments of facts, issues and plans.
- Attends outside appointments, as needed. Maintains appropriate interactions with persons both within the organization and externally. If needed, independently conducts field visits with policyholders, agents and injured workers.
- Handles fatalities and catastrophic cases, such as paraplegia, quadriplegia, catastrophic head injury, major amputation, in the acute stage, and post-acute when appropriate, with guidance from technical experts and claims specialists.
- Establishes initial and ongoing case reserves within authority level that accurately reflect file exposure in accordance with Company reserving guidelines relating to qualitative analysis and timing and/or client service instructions. Recommends reserves for cases that exceed authority level.
- Communicates and educates the employer on case exposure/reserves and how to mitigate the exposure. Communicates and partners with the reinsurer regarding case exposure/reserves, high expense items and issues which impact future costs.
- Provides and documents strategy to bring cases to resolution per the respective business’s best practices, procedures and philosophy. This is evidenced by documenting files in claim comments with 1) timely action plans; 2) pertinent facts and issues for roundtable discussions; and 3) analysis of settlement exposure, including spreadsheets or actuarial advice when appropriate.
- Identifies, analyzes and resolves the majority of payment changes and errors on files. When unable to resolve, actively seeks out and works with Claims Technical to learn for future application.
- Manages data timely and accurately on files to be in compliance with state regulatory reporting requirements, rating bureau reporting mandates and internal data needs.
Business Operations
- Demonstrates the skill set to handle severe claims, and is a resource to other team members handling similar claims.
- Participates in discussions on file strategy. Reviews, documents and approves requests to increase reserves and/or settlements within their authority.
- Assists less experienced representatives in claim management, use of company resources and company services.
- Displays professionalism to internal and external customers. Professionally works with other team members to best serve all customers of the team. This includes, but is not limited to, covering for other team members when they are absent, being respectful of others, and the ability to successfully resolve conflict. Constructively works with team members and others in the company when service and business improvement opportunities are identified.
- Shares thoughts and ideas in team meetings and encourages others to do the same. Demonstrates and promotes positive behavior and attitude among team members. Acts as a mentor to others when requested.
- Seeks out opportunities, and participates in, projects.
- Identifies and communicates trending and claims management practices that could impact the team’s book of business.
- Provides technical and marketing services in order to maintain agency and policyholder/client relationships so as to achieve success with new business goals, retention of renewals and loss experience consistent with team and company goals.
- Learns new jurisdictions when asked.
- Adheres to internal Partnership Agreements.
- Demonstrates understanding and willingness to learn the various fundamentals of insurance finance.
What We'll Love About You:
Education and Experience
- Bachelor’s degree preferred.
- Four or more years of workers compensation lost time experience.
- Pursuit or attainment of a professional insurance designations (CPCU, ARM) preferred.
Knowledge and Skills
- Knowledgeable of state applicable Workers’ Compensation Act and its application to claims administration.
- Knowledge and skills in state regulatory reporting.
- Strong knowledge of medical terminology, anatomy and procedures.
- Awareness of related disability benefits.
- Understanding of insurance finance.
- Excellent customer service and interpersonal skills.
- Outstanding oral and written communication skills.
- Proven ability to effectively interact with a diverse group of customers and business units.
- Ability to assimilate, understand and analyze information from a variety of sources.
- Strong math skills.
- Strong skills in investigating, negotiating and settling claims.
- Strong problem-solving and decision-making skills.
- Strong computer skills (preferable in a Windows environment).
- Effective prioritization, organization and time management skills.
Work Environment and Physical Demands
Regular attendance is required. Work takes place in a semi paperless environment within an office, using a standard office equipment such as computers, phones, photocopies, 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. Travel as needed.
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The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
SFM Companies, EEO/AA Employers.
