Claims Specialist

Cities and Villages Mutual Insurance Company

Claims Specialist

Wauwatosa, WI

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SERVICE FIRST. INSURANCE ALWAYS.

Under the general supervision of the Workers Compensation Claims Manager, this position is responsible for investigating, processing and adjusting workers compensation claims. Some limited travel may be required with limited overnight stays.

WHY JOIN THE CVMIC TEAM:

• The ability to make a difference to our municipal clients/members!
• Great variety in what you do each day
• Flexibility with your schedule, including the ability to work remotely
• A supportive team environment
• Outstanding benefits that include: Company-paid retirement contribution into a Simplified Employee Pension (SEP) Plan: 12.1% of salary, after one year of employment, Company-paid health insurance premiums, and tuition reimbursement for continued opportunities for growth and development!
  
  

View what employees say about working at CVMIC!

Essential Duties & Responsibilities

• Reviews first report of injury forms (WC-12) and follow up with claimants, insureds, medical providers or others in a timely manner to determine compensability
• Files required State forms in a timely and accurate manner
• Processes new claims, sets and monitors reserves
• Maintains up to date files and diaries on all active claims
• Interviews, telephones, or corresponds with municipal client/member representatives, employees, and supervisors, claimants, witnesses and medical personnel; reviews medical and hospital records in a timely manner to determine compensability while maintaining required confidentiality
• Recommends and sets up Independent Medical Evaluations, Vocational Evaluations and assigns Rehabilitation Nurses as necessary
• Reviews and pays medical bills and indemnity benefits. Submits medical bills for third party review
• Identifies and reports claims with re-insurance/excess insurance exposure to the carrier, Claims Manager and CEO
• Exercises discretion within settlement authority to pay, deny or settle claims and establish reserves on claims. Exercises discretion with respect to investigating claims and processing medical bills and indemnity payments. Discretion is also required with respect to all Company procedures to allow for the flexibility needed to process claims properly and in a timely manner
• Recommends litigation when settlement cannot be negotiated; Oversees litigation on contested cases
• Assigns work, provides oversight, and reviews files of the Med-Only Claims Specialist
• Monitors claims to identify and follow up on subrogation opportunities
  
  

Other Duties & Responsibilities

• Attends Administrative hearings
• Conducts claim file review with municipal clients/members
• Provides Workers Compensation training for municipal clients/members as needed
  
  

Qualifications

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• High School Diploma;
• Associates degree (A. A.) or equivalent from two-year college or technical school is preferred;
• Three to five years related experience and/or training; or equivalent combination of education and experience
  
  

Knowledge, Skills & Abilities

Knowledge of:

• The principles and practices of workers compensation claims handling
• Wisconsin Workers Compensation Act, Administrative Code and case law
• Duty disability and long term disability benefits, including 40.63 and 40.65
• Claims software, Outlook, Excel and Microsoft Word or similar business software
• Americans with Disabilities Act (ADA), Family & Medical Leave Act (FMLA), and Medicare set aside laws
  
  

Ability to:

• Accurately calculate and verify indemnity payments as required by the Workers Compensation Act and Wisconsin Administrative Code
• Handle sensitive situations in a professional manner that reflects favorably upon the municipal client/member and Company
• Communicate professionally, timely and effectively both orally and in writing
• Interact effectively with others inside and outside the organization
• Accurately and efficiently read, analyze, and interpret general business periodicals, medical reports, legal reports, and governmental regulations
• Accurately and efficiently write reports and business correspondence.
• Effectively and professionally present information and respond to questions from clients, claimants, medical service providers, attorneys and representatives from governmental agencies
  
  

Certificates, Licenses, Registrations

• Must possess and maintain a valid Wisconsin drivers license during employment.
• Must be able to provide an automobile with liability insurance limits acceptable to the company
  
  

We Make it Easy

Founded in 1901, MRA is a nonprofit employer association that serves more than 4,000 employers, covering more than one million employees.

As one of the largest employer associations in the nation, MRA helps its member organizations thrive by offering the most comprehensive assortment of HR services, information, education, and resources to help build successful workplaces and a powerful workforce.

We partner with these companies working directly with their HR department and leadership to hire their talent. We are a direct line to the company, not an agency recruiter.

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