Claims Representative CO & AZ

Job Description

Job Description

Job Profile

Job Title: Claims Representative

Location: Remote anywhere in the US with CO & AZ experience

Hire Type: Contingent

Pay Range: $40 - $44/hr.

Work Model: Remote

Work Shift: Monday-Friday 8 am – 4:30 pm

Recruiter Contact: Sean Craft I [email protected] I 443-345-3305

Nature & Scope:

Positional Overview

We are seeking an experienced Workers’ Compensation Claims Representative to handle and adjudicate low-level workers’ compensation claims. The ideal candidate will have at least 2 years of direct WC claim-handling experience , with proficiency in Colorado jurisdiction and Arizona licensure or certification preferred. This position involves determining compensability, administering benefits, managing return-to-work efforts, and ensuring compliance with company standards and state regulations—all while delivering high-quality customer service to claimants and clients.

Role & Responsibility:

Tasks That Will Lead to Your Success

• Process and manage low-level workers’ compensation claims, determining compensability and benefits due.
• Monitor reserve accuracy and file required documentation with state agencies.
• Develop and coordinate claim action plans focused on resolution and return-to-work outcomes.
• Approve and issue claim payments within established authority levels.
• Handle subrogation of claims and negotiate settlements as appropriate.
• Communicate effectively with claimants, clients, and internal partners regarding claim actions and updates.
• Maintain accurate and compliant claim documentation and coding.
• Process lifetime and/or defined-period medical claims, including state filings and utilization review decisions.
• Foster and maintain positive client and claimant relationships.
• Support the organization’s quality programs and continuous improvement efforts.

Skills & Experience

Qualifications That Will Help You Thrive

• High School Diploma or GED required; bachelor’s degree preferred .
• Colorado WC jurisdiction proficiency required; Arizona license/certification a plus.
• Minimum 2 years of direct workers’ compensation claim-handling experience , or equivalent combination of education and experience.
• Prior experience managing indemnity and medical-only claims preferred.
• Working knowledge of state-specific workers’ compensation laws and procedures.
• Strong analytical, interpretive, and problem-solving skills.
• Excellent written and verbal communication skills.
• Proficient in Microsoft Office Suite and claims management systems.
• Strong organizational and interpersonal abilities.
• Ability to work independently and collaboratively to meet performance standards.