Workers Compensation Claims Representative

Sunrise System Inc. is currently looking for

• Under the direction of the Claims Team Leader investigates and settles claims promptly, equitably and within established best practices guidelines.

• Receive assignments.
• Reviews claim and policy information to provide background for investigation and may determine the extent of the policy’s obligation to the insured depending on the line of business.
• Contacts, interviews and obtains statements (recorded) from insureds, claimants, witnesses, physicians, attorneys, police officers, etc. to secure necessary claim information.
• Evaluates facts supplied by investigation to determine extent of liability of the insured, if any, and extend of the company’s obligation to the insured under the policy contract.
• Prepares reports on investigation, settlements, denials of claims, individual evaluation of involved parties etc.
• Sets reserves within authority limits and recommends reserve changes to Team Leader.
• Reviews progress and status of claims with Team Leader and discusses problems and suggested remedial actions.
• Prepares and submits to Team Leader unusual or possible undesirable exposures.
• Assists Team Leader in developing methods and improvements for handling claims.
• Settles claims promptly and equitably.
• Obtains releases, proofs of loss or compensation agreements and issues company drafts in payments for claims.
• Informs claimants, insureds/customers or attorney of denial of claim when applicable.
• May assist Team Leader and company attorneys in preparing cases for trial by arranging for attendance of witnesses and taking statements. Continues efforts to settle claims before trial.
• Refers claims to subrogation as appropriate. May arrange for other recovery proceedings as necessary by line of business.
• May participate in claim file reviews and audits with customer/insured and broker.
• Administers benefits timely and appropriately. Maintains control of claim’s resolution process to minimize current exposure and future risks
• Establishes and maintains strong customer relations

• Maintaining system logs
• Investigating compensability and benefit entitlement
• Reviewing and approving medical bill payments
• Managing vocational rehabilitation

• 1-2 years experience handling claims in a relevant line of business would be a plus!
• Basic knowledge of claims handling and familiarity with claims terminologies
• Strong communication and interpersonal skills to be capable of dealing with claimants, customers, insureds, brokers, attorneys etc in a positive manner concerning losses.
• Ability to self motivate and work independently