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Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in processing and analyzing workers compensation claims, ensuring accurate documentation, coding, and compliance with industry standards. Maintains strong client relationships while effectively managing multiple priorities and deadlines.
Highest-signal resume keywords
Workers Compensation KnowledgeClaims AnalysisDocumentation AccuracyProblem SolvingClient Relationship Management
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Claims ProcessingClaims AdjudicationCompensability DeterminationReserve ManagementClaims CodingMedical Claims AdjustmentOffice ExperienceKeyboarding Skills
Soft Skills
Clear ThinkingExcellent JudgmentTroubleshootingDiscretionAbility to Handle Stress
Certifications & Qualifications
High School DiplomaGEDLicenses in TX, MI, or FL
Industry Keywords
Claims IndustryWorkers Compensation ClaimsState Agency DocumentationClient CommunicationMedical Contacts
About the role
Key responsibilities & impact- Analyze reported lower-level workers compensation claims to determine benefits due
- Ensure ongoing adjudication of claims within company standards and industry best practices
- Adjust medical-only claims and minor lost-time workers compensation claims under close supervision
- Support claims representatives, examiners, and leads with larger or more complex claims
- Process workers compensation claims, determining compensability and benefits due
- Monitor reserve accuracy and file necessary documentation with state agencies
- Communicate claim actions and processing with claimants, clients, and appropriate medical contacts
- Ensure claim files are properly documented and claims coding is correct
- Process routine payments, prescriptions, and status reports for lifetime medical or defined-period medical claims
- Maintain professional client relationships
Requirements
What you’ll need- High school diploma or GED required
- Licenses as required; licensing required in TX, MI, or FL
- One (1) year of general office experience or equivalent combination of education and experience required
- Claims industry experience preferred
- Workers compensation knowledge and experience
- Ability to analyze claims and determine compensability and benefits due
- Ability to maintain accurate claim reserves, documentation, and coding
- Clear and conceptual thinking ability
- Excellent judgment, troubleshooting, problem solving, analysis, and discretion
- Ability to handle work-related stress and multiple priorities simultaneously
- Ability to meet deadlines
- Computer keyboarding
- Hearing, vision, and talking abilities
Benefits
Comp & perks- Flexible work schedule
- Referral incentive program
- Opportunity to work in an agile environment
- Career development and promotional growth opportunities
- Medical, dental, and vision coverage
- 401K on day one
- 401K matching
- Paid time off (PTO)
- Disability insurance
- Life insurance
- Employee assistance program
- Flexible spending account or health savings account
- Other additional voluntary benefits