POSITION TITLE: WORKERS’ COMPENSATION CLAIMS REPRESENTATIVE

POSITION SUMMARY:  The Workers’ Compensation Claim Representative performs a variety of professional duties including reviewing, examining, investigating, and analyzing workers’ compensation claims.  Reviews claim documentation for compensability and subrogation issues; computes indemnity benefits and relevant payments; provides information and assistance to member staff, injured employees, claims administrators, and medical and legal professionals.

ESSENTIAL DUTIES:

1. Reviews, examines, investigates, and analyzes workers’ compensation claims in accordance with the Workers’ Compensation Claim Procedure Manual and Wisconsin Statutes.
2. Reviews, examines, investigates, and analyzes complex, litigated, and high-dollar claims under the oversight of the Workers’ Compensation Supervisor.
3. Interacts with injured employees to ensure awareness and understanding of workers’ compensation process, requirements, and eligibility.
4. Prepares and issues notices in accordance with mandated requirements and regularly reviews, and stays abreast, of applicable laws that may impact how claims are processed.
5. Establishes claim reserve levels by estimating the cost of each assigned claim; monitors reserves and updates amounts as necessary. Reserve authority of $100,000.
6. Coordinates medical treatment for injured employees and provides information to treating physicians regarding employee’s medical history, health issues, and job requirements.
7. Assigns files to third-party field investigators or other service providers as required. Monitors and directs their claim activities.
8. Identifies subrogation potential and pursues the process of reimbursement.
9. Serves as a liaison between medical providers, employees, and legal professionals. Informs members of injured employee’s work restrictions and coordinates appropriate accommodations.
10. Uses WMMIC’s risk management information system to include establishing and maintaining claims files; entering and monitoring proper claim reserves; maintaining appropriate file diaries; documenting all file activities timely; maintaining up-to-date file status including claim closure; and approving and authorizing claim payments within authority limit.
11. Reviews and interprets doctor’s reports to ensure that the appropriate disability, impairment, and apportionment have been applied.
12. Assigns attorneys to claims and works with attorney/member on claim appeals.
13. Review OSHA log for assigned members and submit to members by required deadline.
14. Communicates status of claim to Workers’ Compensation Supervisor.
15. Represents WWMIC and the member entity at Workers’ Compensation hearings, as required.
16. Reports lost time wages to the State and manages reporting of Medicare claims (MMSEA).
17. Provides workers’ compensation training to members and member employees.
18. Keeps special handling guidelines up to date for assigned members and assists in review of Workers’ Compensation Procedure Manual.

NONESSENTIAL DUTIES:
Completes other assignments and projects to meet business needs.

BUSINESS CONTACTS:
Internal:  Co-workers, Workers’ Compensation Supervisor, Operations Manager, Executive Director
External: Members, legal and medical professionals, Workers’ Compensation vendors, State agencies

SUPERVISORY RESPONSIBILITY:  None

MINIMUM QUALIFICATIONS (Experience, Education, and Special Certifications)

1. Bachelor’s Degree in Risk Management, Business Administration or related field preferred.
2. Five years’ experience handling Wisconsin workers’ compensation claims required.
3. Associate in Claims (AIC), Associate in Risk Management (ARM), CPCU, or related professional designations a plus.
4. Advanced skills with software applications, preferably Microsoft Office Suite, ISO ClaimSearch, and automated risk management information system such as Riskmaster & Business Intelligence required.
5. Proficient and accurate computer keyboarding skills required.
6. Valid driver’s license, current vehicle insurance, and reliable transportation required.
7. Must reside in WI

KNOWLEDGE, SKILLS, AND ABILITIES

1. Basic knowledge of workers’ compensation claims handling protocols.
2. Working knowledge of Wisconsin workers’ compensation laws and understanding of the role of the Department of Workforce Development.
3. Knowledge of ICD codes.
4. Ability to work independently as well as on a team.
5. Ability to interact effectively and professionally with all levels of individuals both internal and external.
6. Effective and thorough analytical and problem-solving skills.
7. Professional and effective written and verbal communication skills.
8. Attentive listening skills to understand what people are communicating.
9. Ability to handle, work with, and maintain confidential and sensitive information.
10. Ability to articulate ideas and information verbally and in writing in a clear, tactful, and diplomatic manner.
11. Ability to manage multiple tasks simultaneously while remaining calm under pressure.
12. Knowledge of multiple computer software applications, preferably Microsoft Office Suite and automated risk management software.
13. Proficient and accurate data entry and keyboarding skills with a strong attention to details.
14. Ability to create and work on documents in various computer software applications efficiently and accurately.
15. Effective time management skills.
16. Efficient organizational skills.

PHYSICAL DEMANDS
The physical demands described below are representative of those that must be met by an employee to successfully perform the essential duties of this job.  Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of this job.

While performing the duties of this position, the employee is regularly required to talk and hear.  The employee is frequently required to sit for long periods of time and use a computer keyboard, monitor, mouse and telephone.  The employee must occasionally lift and/or move up to 10 pounds.  The employee may occasionally travel on company business using various modes of transportation (airplane, bus, tax train, rental car, etc.) and must have the ability to travel with no restrictions.  The employee is required to have the following specific vision abilities:  close vision, peripheral vision, depth perception, and ability to adjust focus.

WORK ENVIRONMENT
The work environment characteristics described below are representative of those an employee encounters while performing the essential duties of this job.  Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

While performing the duties of this job, the employee works in an office environment.  The noise level in the work environment is usually quiet, although conversations can be heard.  The employee may occasionally travel on company business using various modes of transportation (airplane, bus, taxi, train, rental car, etc.) as required.

To apply please send your cover letter and resume to Sara Veith, sveith@wmmic.com

POSITION TITLE: LIABILITY CLAIMS REPRESENTATIVE

Position Summary

Under the direction of WMMIC management, the employee in this position is responsible for working with WMMIC member representatives, claimants, and others toward the successful implementation of the company’s claims philosophy and liability claim handling policies. This position will handle Auto Liability, General Liability, and Property Damage claims.

Essential Duties

• Investigate claims and obtain relevant facts to determine coverage, liability, and damages.
• Utilize Wisconsin governmental immunities and tort caps when appropriate.
• Recognize and act on risk transfer opportunities.
• Oversee legal and medical aspects of claims. Including:
           Litigation management of claims in suit
           Bodily Injury evaluations

• Assign and direct the work of outside adjusting firms as needed.
• Effectively utilize WMMIC’s risk management information system to:
          Establish and maintain claims files
          Enter and monitor proper claim reserves
          Maintain appropriate file diaries
          Document all file activities timely
          Maintain up-to-date file status, including claim closure,
          Approve and authorize claim payments (within authority),

• Establish and maintain effective communication and professional working relationships with WMMIC members, claimants, service providers, co-workers, and others.
• Communicate the status of claims with members and WMMIC management.
• Manage claim settlements within authority limits.
• Attend educational workshops
• Assist in all necessary Reporting as required by local, state for federal statutes.
• Ability to travel overnight (up to 1-2 nights per quarter)
• Perform other duties as assigned

MINIMUM QUALIFICATIONS (Experience, Education, and Special Certifications)

• Education: Bachelor’s degree preferred
• Experience: Up to two years of related claim handling experience or other comparable experience
• Associate in Claims (AIC) or other designations desirable
• Experience in municipal government claims desirable
• Must reside in WI

KNOWLEDGE, SKILLS, AND ABILITIES

• Excellent written and verbal communication
• Proficient in the use of Microsoft Suite products
• Quality and customer service focused
• Exceptional organizational skills and ability to give attention to detail
• Ability to comprehend and interpret a variety of documents including state and federal regulations and standards related to loss control/risk management.
• Excellent decision-making and analytical skills
• Self-starter with a strong work ethic and time management
• A commitment to excellence

PHYSICAL DEMANDS

The physical demands described below are representative of those that must be met by an employee to successfully perform the essential duties of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of this job.

While performing the duties of this position, the employee is regularly required to talk and hear. The employee is frequently required to sit for long periods of time and use a computer keyboard, monitor, mouse, and telephone. The employee must occasionally lift and/or move up to 10 pounds. The employee may occasionally travel on company business using various modes of transportation (airplane, bus, taxi, train, rental car, etc.) and must have the ability to travel with no restrictions. The employee is required to have the following specific vision abilities: close vision, peripheral vision, depth perception, and ability to adjust focus.

WORK ENVIRONMENT

The work environment characteristics described below are representative of those an employee encounters while performing the essential duties of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform essential functions.

While performing the duties of this job, the employee works in an office environment. The noise level in the work environment is usually quiet, although conversations can be heard. The employee may occasionally travel on company business using various modes of transportation (airplane, bus, taxi, train, rental car, etc.) as required.

To apply please send your cover letter and resume to Sara Veith, sveith@wmmic.com