Job Description:

Claim Processor - Worker's Compensation

Job Locations

US-WI-Merrill | US-PA-Mechanicsburg

Overview

In accordance with application of state and federal laws and company best practices, provide claimants and insureds with clear and correct instructions regarding the claim process. Process basic claims by verifying coverage, obtaining and documenting necessary information for the claim, and issuing appropriate payments as directed.

Responsibilities

I. Process newly reported claims, initiate basic claim investigation, and redirect moderate and complex claims to a higher level Claim Representative as required.

II. Perform Claim Processing System entry and maintenance, including file setup, coverage verification, applicable coding, establishing reserves, and issuing payments.

III. Verify coverage and determine our obligation(s) to the insured and/or claimant.

IV. Review claims to determine type of claim presented, claim documentation/evidence presented, amount of claim, or amount due.

V. Establish and monitor case reserves for adequacy during the life of the claim.

VI. Review loss for subrogation potential and refer to the Subrogation Specialist, if appropriate.

VII. Provide additional instruction to insured or request additional information.

VIII. Submit necessary state filings and create and send appropriate required state notices and letters.

IX. Complete the claim process by obtaining and reviewing support documentation in accordance with existing state laws and fee schedules and make appropriate payments.

X. Assist other claim handlers as requested.

XI. Discuss the following types of situations with your supervisor for guidance and direction:

A. Coverage or claim handling questions.

B. First and third claim denials or denials of claim compensability.

C. Questionable coverage or liability claims or claimed dollar amounts that exceed your stated authority level.

D. Lost time/indemnity claims.

E. Unresolved complaints by customer or regulatory official.

F. Permanent disability claims.

G. Claims with subrogation potential.

H. Allegations of bad faith claim handling.

Qualifications

1. Prior Experience:

* Two years of insurance processing and/or equivalent customer service work experience.
* Prior claim processing experience is preferred.

2. Education:

* High school diploma or equivalent is required. Associate degree in insurance or business preferred.
* Additional courses in insurance and/or medical terminology desirable.

3. Necessary Knowledge and Abilities:

* Ability to obtain and maintain state adjusting license requirements and complete continuing education requirements.
* Ability to deal effectively and provide positive customer service with insureds and claimants by phone, email, and in writing.
* Proficient keyboarding skills.
* Able and willing to follow instructions.
* Possess a positive attitude.
* Ability to handle rush or unexpected assignments.
* Ability to acquire knowledge of insurance terminology.

Church Mutual is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran or disability status.

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