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VCU Health System's Workers' Compensation is seeking a full time Workers' Compensation Claims Representative II. Their primary duties will be to accurately investigate and process General Liability, Property and/or Workers' Compensation claims for VCUHS employees, visitors and patients in a timely and fair manner; assist in the coordination of an effective Insurance and Workers' Compensation Claim Program that is compliant with state laws and that meets the needs of VCUHS; responsible for handling assigned claims appropriately; maintain effective communication with claimants/injured worker, medical staff (treating physician) and all other customers as appropriate; and manage low to medium complexity claims with a total dollar value between $500,000 to $2,000,000 dollars.
Determines acceptance and/or compensability of claims, including the investigation, evaluation, and settlement of claims.
Establishes reasonable reserves.
Authorizes payments within authority.
Develops recommendations to the Claims Council (senior management oversight committee). Coordinates medical management on WC claims, litigation management, and acts as a Return-To-Work liaison for the company.
May provide oversight to clerical and temporary office personnel. This oversight will include providing specific technical direction and training for medical bill review and document management as appropriate.
If available during any emergency (can be reached by telephone), it is expected that the WC Claims Representative II will provide oversight and claim assistance as needed including but not limited to returning to the affected site and/or coordination of claim staff and emergency personnel from a remote location.
Bachelors in Business, Finance, or related field from an accredited program
Minimum of two (2) years of progressively more responsible Workers' Compensation claims adjudication and multi-line claim experience
Previous experience in Microsoft applications (Word, Excel, etc.)
Bachelor's Degree in Business, Finance, or related field from an accredited program
Three (3) years of claim handling experience
Previous Paralegal and progressive claim experience
Qualified applicants will receive consideration for employment without regard to their protected veteran or disability status.