Workers Compensation Associate – Claim Representative

• Participate in structured training classes covering insurance policies, claim processes, systems, and procedures
• Complete virtual, classroom, and on-the-job training
• Assist in reviewing, investigating, and documenting Workers Compensation claims under close supervision
• Investigate, develop, and evaluate action plans for claim resolution
• Assess coverage and determine claim compensability, including evaluating potential fraud
• Participate in telephonic and/or onsite file reviews
• Learn to determine coverage, compensability, and exposure based on policy terms and claim facts
• Gather information from policyholders, claimants, witnesses, and third-party providers
• Communicate claim status to business customers, injured employees, medical providers, and legal counsel
• Maintain accurate claim activity records in claim management systems
• Help return injured parties to work when appropriate, including coordinating medical treatment
• Demonstrate openness to continuous learning, particularly in AI and digital transformation
• Acquire and maintain relevant insurance licenses within three months of starting
• Perform other duties as assigned

• High School Diploma or GED
• One year of customer service experience
• Bachelor’s Degree listed among ideal candidate qualifications
• Previous internship or work experience in customer service or insurance
• Willingness to obtain an active adjuster license where required by state law
• Proficiency in Microsoft Office, including Word, Excel, and Outlook
• Willingness to learn claims management
• Strong verbal and written communication skills
• Ability to exercise sound judgment and make effective decisions within established authority
• Exceptional customer service skills
• Attention to detail and organizational skills
• Ability to manage multiple tasks and prioritize effectively
• Basic conflict resolution skills
• Openness to continuous learning
• Ability to acquire and maintain relevant insurance license(s) within three months of starting

Demonstrates proficiency in claims management and customer service, with strong communication skills and attention to detail. Capable of investigating and documenting Workers Compensation claims while maintaining accurate records and exercising sound judgment.

• Claims Management
• Customer Service Experience
• Insurance License Acquisition
• Microsoft Office Proficiency
• Verbal And Written Communication Skills

• Claims Investigation
• Documentation
• Coverage Assessment
• Fraud Evaluation
• Action Plan Development
• Record Maintenance
• Medical Treatment Coordination
• Conflict Resolution

• Attention To Detail
• Organizational Skills
• Sound Judgment
• Multi-tasking Ability
• Openness To Continuous Learning

• Adjuster License

• Workers Compensation
• Insurance Policies
• Claim Processes
• Claim Compensability
• Telephonic File Reviews

• Claims Management Systems
• Microsoft Word
• Microsoft Excel
• Microsoft Outlook