Claim Representative I - Central
The Claim Representative I is an entry-level professional responsible for handling workers' compensation claims, including medical and indemnity benefits. The role involves investigating claims, determining compensability, managing reserves, negotiating settlements, and ensuring compliance with relevant laws while collaborating with internal and external stakeholders. This position supports cost containment and facilitates injured employees' return to work, operating in a hybrid work environment.
About Careertakes
👉 Important disclosure: Careertakes is a third-party recruiting platform supporting this hiring process. If selected, you will be employed directly by our client, Legal.
Applicants for this role may also receive access to additional matched opportunities through the Careertakes platform.
What You’ll Do
This entry-level claims role handles medical-only and indemnity workers’ compensation claims. You will investigate, evaluate and manage claims through timely resolution, while working within settlement and reserve authority.
- Verify workers’ compensation coverage for employers and injured employees
- Investigate claims to determine compensability and causal relationship
- Manage medical billing and approve payments tied to treatment and injury relationship
- Establish appropriate reserves based on claim profile and anticipated exposure
- Negotiate settlements with injured parties or attorneys within authority limits
- Close files after resolution to meet internal and state performance and compliance standards
- Document claims with subrogation potential and work toward recovery when applicable
- Coordinate return-to-work activities and support rehabilitation efforts
- Escalate complex files to management and coordinate with outside vendors for cost containment
- Maintain strong working relationships with internal and external customers
- Stay current on workers’ compensation statutes, case law, and best practices
Qualifications
- Bachelor’s degree in a related field, or equivalent combination of education and experience
- Minimum of 1 year relevant experience or completion of a claims trainee program
- Certification or progress toward certification preferred and encouraged
- Bilingual skills are a plus
Skills & Abilities
- Proficiency with computers and standard office/claims software
- Knowledge of medical and legal terminology related to workers’ compensation
- Familiarity with workers’ compensation laws and jurisdictional regulations
- Strong oral and written communication skills
- Effective customer service and conflict resolution skills
- Ability to prioritize, manage multiple tasks, and meet deadlines
- Attention to detail and strong analytical ability
- Ability to work independently and as part of a team
Working Conditions & Location
- Work may be performed in an office setting or remotely (telecommute eligible). Minimal travel required.
- Must be legally authorized to work in the United States.
Compensation
- Pay range (provided by the employer): $48,200 - $80,750 per year.
- Actual compensation depends on internal equity, candidate skills and experience, geographic location, market factors, and other considerations.
About the Hiring Organization
Careertakes is assisting this hiring process as a third-party recruiter. The position will be with a Confidential Client in the Legal industry. Careertakes provides candidate matching and placement support; the Confidential Client makes final hiring decisions.
Equal Opportunity & Hiring Transparency
Careertakes and our client are Equal Opportunity Employers committed to building a diverse and inclusive workforce. We prohibit discrimination or harassment of any kind. To support a fair and efficient hiring process, AI tools may be used to assist with application review or resume screening. These tools do not replace human decision-making. Final hiring decisions are made by people.
If you have questions about how your data is used, please contact us directly.
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