Claims Professional - Workers' Compensation
Company: SFM Companies (SFM Mutual Insurance)
Location: Des Moines
Posted on: January 21, 2025
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Job Description:
As a Claims Professional you will handle Workers' Compensation
claims for WI and MN. The primary focus will be Minnesota claims
for the assigned risk pool but you will also manage claims for
Wisconsin. Using your experience handling workers' compensation
claims, you will conduct investigations and manage claims in
accordance with state workers' compensation statutes, case law, and
Company best practices. You will calculate lost wages and manage
complex medical claims, and will handle the claim from start to
finish.
This is a customer focused position and claims are handled so that
a successful resolution is achieved for all parties. Working
collaboratively in a multifunctional team is key to being
successful in this role. The multi-functional team environment is
what makes SFM different from other companies. You will find our
systems are designed to help our Claims Reps handle claims
efficiently because it was created for exclusively for work comp
claims. Experienced adjusters are encouraged to apply and will be
considered for a higher level. Your job title and salary will be
determined based on the experience you offer. Expreince handling
lost time claims is a must.
This is a work from home position, but applicants will need to live
in MN, WI, or IA. Some travel to Corporate HQs in MN is required.
Experience handling MN WC claims is highly desirable.
Salary Range: $66,396 USD to $92,955
Our benefits include:
Affordable Medical, Dental, Vision Insurance, HSA, FSA
Flexible hybrid work environment
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
Discounts on gym memberships, fitness apps and weight loss
programs
Adoption financial assistance
Benefits include a flexible work environment, health/dental
insurance that includes supplemented dependent care coverage,
generous PTO, student loan payback, a bonus program, 401k with
match and much more!! Being able to work in a collaborative
environment is key to being successful at SFM. We believe that our
exceptional and motivated employees are our greatest strength and
we are committed to creating the best work environment to ensure
your success.
Responsibilities:
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. Involve strategic business
partners, 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 and legal
services pursuant to the respective business's procedures, client
service instruction and applicant state law. This includes
documentation in claim comments of facts, issues and plans.
If needed, attends field visits of policyholders, agents and
injured workers, with assistance as needed. May include travel.
Establishes initial and ongoing case reserves within authority
level that accurately reflect file exposure in accordance with
Company best practices and client reserving guidelines relating to
qualitative analysis and timing. 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
SFM 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, with assistance, the
use of spreadsheets.
Qualifications:
Bachelor's degree preferred.
Six months or more of workers compensation lost time experience
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.
Understanding of insurance finance.
Excellent customer service and interpersonal skills.
Good oral and written communication skills.
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.
Developing skills in investigating, negotiating and settling
claims.
Problem-solving and decision-making skills.
Acts as a mentor to others when requested.
Strong computer skills (preferably in a Windows environment.)
Effective prioritization, organization and time management
skills.
Demonstrates positive teaming skills focused on team results.
Physical Requirements:
Regular attendance is required. Work takes place in a semi
paperless environment within an office setting, either on business
premises or remote location, using standard office equipment such
as computers, phones, and photocopiers, 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.
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.
About SFM
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.
Join us!! Click "Apply" Now
_________________________________________________________________
SFM Mutual Insurance Company and each of its parent companies,
subsidiaries and/or affiliated companies are Equal
Opportunity/Affirmative Action Employers. SFM provides equal
employment opportunities to all employees and applicants for
employment and prohibits discrimination and harassment of any type
without regard to race, color, religion, age, sex, national origin,
disability status, genetics, protected veteran status, status with
regard to public assistance, sexual orientation, gender identity or
expression, or any other characteristic protected by federal, state
or local laws.
SFM Companies, EEO/AA Employers. SFM is a participant of E-Verify.
Applicants have rights under Federal Employment Laws.
Keywords: SFM Companies (SFM Mutual Insurance), Waterloo , Claims Professional - Workers' Compensation, Other , Des Moines, Iowa
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