Claim Representative
Job description
Claim Representative
Commitment: Full-time (35 hours/week. 8am - 4pm)
Location: Burlington, MA (hybrid)
The Claim Representative is responsible for the equitable and justified management of medical only claims in accordance with A.I.M. Mutual Insurance Company’s specified service standards, industry requirements and audit procedures. The Claim Representative complies with all state and Federal regulations to manage claims clearly covered within the workers compensation statute, do not involve lost time beyond the statutory waiting period, and the lowest severity injuries with minimal medical care.
Key Responsibilities:
- Evaluate coverage, liability, disability, and causal relationship issues as well as potential loss value immediately
upon receipt of first report, and during life of claim. - Properly document and ensure prompt payment or denial within specified time‐period.
- Review and stay current with the claim file diary list and evaluate claims for closure or reassignment.
- Assess and identify claims no longer meeting the definition of Medical Only as defined by the Company Best
Practices and inform supervisor for reassignment to a lost‐time adjuster. - Contact policyholders and injured workers by telephone regularly to obtain necessary information.
- Ensure expedient payment of medical bills associated with assigned claims.
- Bring all claims assigned to a prompt and fair conclusion.
- Interact with customers, medical providers, and vendors on general case issues, providing complete and
accurate information in a professional manner.
Minimum Requirements
- College degree preferred.
- Experience working within a call center or customer service environment preferred.
- Ability to organize and prioritize workflows and meet company/industry deadlines.
- Self‐motivated, able to work with little direction.
- Has or is willing to pursue a professional insurance designation.
The above is a description of the ordinary duties of the position. It should be expected that from time-to-time other duties, both related and unrelated to the above, may be assigned and required.
Who We Are
At A.I.M. Mutual Insurance Companies, we are committed to setting the standard in service excellence. We are guided by our founding principles to help employers effectively manage their workers’ compensation program, providing quality services to injured workers and creating safe workplaces. We are one of the largest regional workers' compensation specialists, and we credit our staff for putting their service-oriented work ethic and workers' compensation insurance knowledge into practice, every day, in all they do.
What we do...We provide a workers' compensation experience that ensures peace of mind for all.
Why we do it...To protect and support the well-being of all New England workers and their families.
How we do it...
- Listening with empathy
- Acting with compassion
- Doing the right thing
- Succeeding through collaboration
Thank you for your interest in joining the A.I.M. Mutual Insurance team!