Workers Compensation Claims Specialist

Worker’s Compensation Claims Specialist

We are a sought-after place to work based on the extensive and contemporary training, development, and career advancement we provide for our team members. You will be part of a fast-growing organization that consistently offers growth opportunities to those within the organization. Our leaders listen to new, fresh ideas and perspectives, which keeps the organization focused on being agile and open to new opportunities.

You’ll enjoy a 37.5-hour work week where you will not work weekends or holidays. We take pride at Metis in focusing on our team members' well-being. The Worker’s Compensation (WC) Claims Specialist, working independently and exercising good judgment and discretion, is responsible for the investigation and management of WC claims files within his/her assigned territory.

ESSENTIAL FUNCTIONS AND RESPONSIBILITIES

1. Provides a high level of client service to both external clients as well as interfacing with other departments and staff.

2. Follows best practices, ensuring compliance with Company standards and policies, strictly adhering to industry, state and federal regulations.

3. Participates in routine claims operations including claims evaluation, adjudication and client service in accordance with agreed quality and production standards.

4. Meets all department performance standards as set.

5. Determines compensability of a WC claim, following up to make certain that disability is determined, that the payments are ready on time, and ensuring the disability management process is followed. .

6. Assigns Nurse Case Managers and Vocational Rehabilitation Specialists as needed.

7. Assists with lawsuits, working with management, staff, and outside attorneys.

8. Negotiates and settles claims when appropriate based on severity or complexity of claim/lawsuit within pre-set authority.

9. Collects information and prepares reports as requested.

10. Keeps the Workers’ Compensation Claims Supervisor informed of all activity outside pre-set guidelines.

11. Works collectively with all staff to promote a positive work environment.

12. Conducts all business in accordance with Company policies and procedures.

QUALIFICATIONS AND CREDENTIALS

Education and Experience

• College degree required.
• 10 years’ experience in WC claims handling with a solid understanding of policy analysis and associated legal issues.
• Possession of a current AIC designation in good standing preferred.
• Strong computer skills required.

Driving Requirements

Travel may be occasionally required. Use of a Company car or personal vehicle will be necessary. Proof of a valid driver’s license, an acceptable DMV record, and liability insurance is required.

Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity or expression, pregnancy, age, national origin, disability status, genetic information, protected veteran status, or any other characteristic protected by law.

Job Type: Full-time

Pay: $55,000.00 - $60,000.00 per year

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Flexible spending account
• Health insurance
• Health savings account
• Life insurance
• On-site gym
• Paid time off
• Parental leave
• Referral program
• Vision insurance

Schedule:

• Monday to Friday

Work setting:

• Call center
• In-person
• Office

Education:

• Bachelor's (Required)

Experience:

• Customer service: 5 years (Preferred)
• Worker's Comp Claims: 10 years (Required)

License/Certification:

• AICP Certification (Preferred)

Work Location: In person