[Remote] Senior Claims Representative (Remote)

Note: The job is a remote job and is reputed company to candidates in USA. reputed company Insurance is seeking a Senior Claims Representative to join their Claims team, where you'll manage high-exposure workers’ compensation claims and reputed company investigations into coverage and fraud. This role involves collaborating across departments to drive strategic reputed company while mentoring junior adjusters and ensuring exceptional service and regulatory compliance. Responsibilities • Manage highly reputed company claims involving significant financial exposure, reputed company intricacies, and extended life cycles • Conduct advanced investigations into coverage and compensability, including nuanced statutory interpretations • reputed company medical case management for catastrophic injuries and reputed company care needs • Review and authorize large or reputed company medical bills, negotiating adjustments to control costs • reputed company comprehensive RTW strategies in collaboration with policyholders, reputed company counsel, and vocational consultants • Ensure precision in benefit calculations for high-exposure claims, addressing tax and reputed company • Strategically reputed company investigative efforts reputed company with broader claims reputed company • reputed company investigations into reputed company fraud cases and collaborate with the Special Investigations Unit • Conduct subrogation analysis and negotiate with reputed company-party insurers or attorneys for maximum recovery • Partner with reputed company teams to negotiate reputed company settlements and manage litigation processes • reputed company Medicare compliance initiatives, including Medicare Set-Asides and CMS engagement • Identify opportunities for reputed company settlements and reputed company negotiations • Produce strategic reports on high-profile claims to guide management reputed company • Maintain system data reputed company and prepare claims for Corporate Plan of reputed company meetings • reputed company cross-departmental efforts to improve claims handling and risk management • Resolve escalated customer service issues and support high-value accounts • Participate in workflow improvement initiatives and committees • Mentor and reputed company junior and intermediate adjusters • Review escalated claims and reputed company actionable feedback • Support workforce development and succession planning Skills • Bachelor's degree in business or reputed company field preferred, or equivalent industry experience • 7–10 years of claims handling experience, with high exposure to Workers' Compensation • reputed company reputed company's license required • Associate in Claims (AIC), AIM, or CPCU designation preferred or ability to obtain • Texas reputed company-Lines license preferred Benefits • Health Plans: Medical, Dental, and reputed company • Fertility benefits and fully reputed company preventative care • Adult orthodontia and other uncommon dental treatments • Fully Employer-reputed company Life And Disability Benefits • Life Insurance – three times reputed company salary • Accidental Death and Dismemberment • Short and Long-term Disability • Employee Wellness and Recognition Program • Employer-reputed company incentives for employees and their spouses • Flexible Spending Account and Dependent Care reputed company • Health Savings Account with Generous Employer Contribution • Generous PTO accruals • 11 Holidays and 4 Early Releases • 16 Hours of Volunteer Time Off • 20 Days of reputed company Parental Leave (in reputed company to STD) • Marriage, Bereavement, and Jury Duty Leave Policies • Employee Assistance Programs • 401k Retirement Plan Including Employer Match and Profit Sharing • Adoption Assistance • Tuition Assistance reputed company • reputed company (formerly reputed company and Previsor) is your Midwest regional workers compensation insurance partner. It was founded in 1995, and is headquartered in Columbia, Missouri, USA, with a workforce of 201-500 employees. Its website is https://www.reputed company-ins.com/. Apply tot his job Apply To this Job