Pinnacol Assurance · 12 hours ago
Claims Representative
Denver
Full-time
Onsite
Entry Level
$60K/yr - $64K/yr
2+ years expPinnacol Assurance is dedicated to providing caring workers’ compensation protection to Colorado employers and employees. The Claims Representative will manage claims and related issues, ensuring expedient and cost-effective resolutions while providing quality customer service to all stakeholders.
BankingFinance
Responsibilities
Work with team members to strategically and proactively manage claims and claim-related issues to the most expedient, cost effective resolution; provide quality customer service to all stakeholders
Identify claims that need additional management and work with team members to resolve concerns or escalate to the appropriate level
Contact stakeholders as required by Company best practices on incoming claims to promptly investigate circumstances of accident and injury, investigate and determine compensability, and identify and address red flag issues, including late reporting, pre-existing medical issues, designated medical provider process and referral issues, medical treatment issues, legal issues, and potential subrogation and penalty issues
Manage the relationships with your stakeholders in order to obtain timely and accurate information
Effectively communicate your decisions and evaluate for customer understanding
Determine compensability as required by Company best practices, case law and the Colorado Workers’ Compensation Act
Proactively manage open claims as required by Company best practices, including expedient and cost effective medical case management, disability management and litigation management as well as identification, investigation, management and resolution of potential adverse claim development, including prior injuries, comorbid and pre-existing medical conditions, migrating body parts, worsening medical conditions and delayed recovery, change of physician requests, multiple claims, multiple jobs, subrogation, penalties and offsets, etc
Facilitate all necessary resources on a timely basis for optimal claim management, action plan development and claim resolution, including other claims team members, Claims Lead, Claims Owners, Underwriter, Business Director, Legal resources, Return-to-Work Consultant, Safety Consultant, Medical Case Manager, Utilization Review, MedPay Liaison, Provider Relations Specialist, Claims Director, Claims Specialist and Claims Manager
Proactively communicate and correspond with stakeholders as needed to manage and resolve open claims, including but not limited to policyholders, injured workers, agents, medical providers, service vendors and resources, attorneys and regulatory agency representatives
Facilitate early return to work for injured workers by working with policyholder, and Return-to-Work Consultant if needed
Facilitate and coordinate benefit authorization and payment on compensable claims as required by Company best practices, case law and the Colorado Workers’ Compensation Act
Evaluate and negotiate claims for settlement as required by Company best practices
Educate and inform policyholders and agents on workers compensation and the status of individual claims status and significant development as required by Company best practices
Review all medical information received on claims periodically in order to determine if authorization/payment is appropriate, or a referral is needed to other Company resources (utilization review, medical case manager, physician advisor, or others) as required by Company best practices and in compliance with DOWC Rules of Procedure
Set and maintain current, accurate and adequate reserves on all open claims according to company best practices
Prepare for, attend and testify at settlement conferences and hearings as determined appropriate by leadership
Evaluate medical bill referrals to determine relatedness to claim and appropriateness of the bill as required by Company documented best practices. Authorize payment of the bill or deny bill by obtaining appropriate supporting documentation. Communicate decisions to billers and parties to the claim
Read and analyze medical records in order to maintain a current and accurate understanding of a claims’ medical progress. Recognize when a treatment plan is outside of the authorized care. Communicate with internal and external resources to assist stakeholders with their management of the treatment plan. Process records as required by Company documented best practices
Serve as resource to other claims representatives as requested by the business team as well as the claims discipline as needed
Serve on projects and committees as requested
Continue education toward management of increasingly more complicated claims to prepare for Claims Representative II
Other duties as requested
Qualification
Required
2 or more years previous experience working directly with customers
Comfortable managing difficult conversations
Comfortable using technology and multiple systems
Successfully complete training and claims assessments within six months
Benefits
You’ll get to choose from diverse benefit offerings for medical, dental and vision.
We enjoy a positive, collaborative work environment.
Enjoy 20 paid days off your first full year plus 9 paid holidays.
Sign up for unique wellness programs, including on-site, company-paid fitness facilities and classes.
We promote a learning culture to help you master your current job and cultivate the skills of the future through a variety of on-site, online, and off-site professional development opportunities.
Through our employee volunteer program, Pinnacol in Action, employees receive paid time off to volunteer with Colorado nonprofits.
You’ll have the opportunity to earn a quarterly incentive, up to 12 percent of your annual base salary, when your team exceeds their goals and objectives.
Company
Pinnacol Assurance
Pinnacol Assurance is provide personalized attention that helps keep worksites safe.
501-1000 employees
Funding
Current Stage
Late StageLeadership Team
Philip Kalin
President/CEO
Kathy Kranz
Vice President and Chief Financial Officer
Recent News
2025-10-02
2025-09-14
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