WC Hearing Representative

Job Summary

• Handles a high-volume workload of moderately complex to complex workers compensation claims.
• Collaborates with claim owners to support lien resolutions, litigation tasks, and other core claims functions within prescribed authority limits.
• Represents the interest of the company while working to resolve workers compensation claims.
• Performs work independently with minimal guidance from a supervisor.

Essential Job Functions

• Attends virtual and in-person hearings, trials, and conferences to represent the interest of the company.
• Presents company position before Workers Compensation Appeals Board (WCAB).
• May participate in negotiation of settlements or litigation to resolve claims within prescribed authority limits.
• Coordinates filings upon lien resolution.
• Partners with claim owners to conduct investigations and determine compensability.
• Reviews medical and disability rating reports to build case defenses and determine settlement values for disputed lien matters.
• Evaluates indemnity benefits owed and explains to pertinent parties.
• Sets corresponding reserves accordingly and issues claim payments.
• May authorize or coordinate medical care.
• Contacts pertinent parties to gather all relevant information, documents, and evidence related to claims.
• Prepares file materials to present company position at hearings, trials, and conferences.
• Establishes and maintains file control diary.
• Assists with legal tasks within purview.
• Performs other duties as assigned.
• Participates in the design, development, and presentation of training about the handling and settlement of workers compensation claims.
• Stays informed about updates to workers compensation laws and regulations.
• Uses in-depth knowledge to act as a resource for peer learning.

Physical Actions

Besides sedentary work, job duties require some or all of the following physical activities: Carrying and lifting up to 25 pounds, hearing, seeing, standing and walking (including up and down stairs and steps).

Education Requirements

• High School Diploma or equivalent required.
• Bachelors degree preferred.
• Must maintain professional certification or licensing where required.

Experience Requirements

• Experience as a workers’ compensation claims representative, medical lien representative, hearing representative or similar role preferred.

 

Candidate qualifications may be reviewed against the requirements for the associated levels of this position's core function.  Salary grade will be based on selected candidates' experience and skills.