Emergent Holdings · 5 hours ago
Claim Representative I
United States
Full-time
Remote
Entry Level
$46K/yr - $77K/yr
1+ years exp
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Responsibilities
Verifies coverage on all claims assigned to the adjuster.
Determines compensability by thorough investigation of the claim.
Determines causal relationship to ensure appropriate payment of benefits.
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 bills directly associated with the claim. Approves payment where appropriate.
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.
Qualification
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Required
Bachelor’s degree in a related field.
Minimum one-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.
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
Relevant combination of education and experience may be considered in lieu of degree.
Certification or progress toward certification is highly preferred and encouraged.
Bilingual skills preferred.
Company
Emergent Holdings
Emergent Holdings’ elite team makes lives, companies and communities better! Emergent Holdings is driven by a singular goal — improving the health and safety of our customers and our communities.
1,001-5,000 employees
Funding
Current Stage
Late StageLeadership Team
John S. Roberts
Executive Vice President, Emerging Markets & Chief Administrative Officer
Brittanie Benson
Human Resources Business Partner
Company data provided by crunchbase
