Senior Work Comp Claims Professional bei None

Sr. Workers Compensation Claims Professional

SFM – The Work Comp Experts

Work somewhere you love

SFM is unique in that we are small enough that your voice is heard but has all the benefits and perks of a larger employer. We value your opinion, help you reach your goals, and make it easy for you to maintain a work-life balance. SFM is committed to creating the best work environment and believes that our exceptional and motivated employees are our greatest strength. SFM emphasizes work life balance, and our benefit package is designed to assist you navigate your work-life journey.

Our benefits include:

• Affordable Medical, Dental, Vision Insurance, HSA, FSA
• Flexible hybrid work environment
• Traditional and Roth 401(k) plans with company match
• Company contributions to help pay off student loans
• Monthly home internet allowance
• Free life insurance, STD & LTD
• Opportunities for annual gainshare bonus 
• Pet insurance
• Generous PTO
• 9 paid holidays 
• Paid parental leave
• Annual company-wide volunteer day
• Discounts on gym memberships, fitness apps and weight loss programs
• Adoption financial assistance

Visit our careers page to learn more about working at SFM.  

About SFM

Since 1983, our mission has been to be the workers’ compensation partner of choice for agents, employers and their workers. In that time, we’ve expanded to well over 25,000 customers in the Midwest and grown our offerings to include vocational rehabilitation, loss prevention, medical services and more. Though much has changed through the years, our focus continues to be unrivaled customer service, safety, and providing better outcomes for employers and injured workers. SFM’s mission is to create a safer workplace by protecting workers from harm and the work that we do at SFM contributes to the well being of workers' and employers alike. 

 The role

 Working as a Sr. Claims Representative you will manage complex Workers' Compensation claims for the state of Minnesota following SFM’s mission to do the right thing!   Using your experience handling workers' compensation claims, you will conduct investigations and manage claims in accordance with state workers’ compensation statutes, case law, and Company best practices. You will calculate lost wages and manage complicated medical claims and will do so “from cradle to grave”.  This is a customer focused position and claims are handled so that a successful resolution is achieved for all parties. Working collaboratively in a multifunctional team is key to being successful in this role. The multi-functional team environment is what makes SFM different from other companies. You will find our systems are designed to help our Claims Reps handle claims efficiently because it was created exclusively for SFM.  Experienced adjusters are encouraged to apply.   Experience handling lost time claims is a must.  Remote work or hybrid work is offered. Applicants can live in MN, SD, IA or WI.  South Dakota claims handling experience is nice to have. 

What you will be doing 

1. Makes timely contact with all parties to a claim to gather necessary information to determine liability and fulfill regulatory, contractual and internal reporting requirements. Applies the workers’ compensation statute and case law to facts to determine compensability. Uses internal resources as required by company best practices or client servicing instructions for questionable compensability decisions and subrogation or fraud issues.
2. Sets expectations with the injured worker and employer of wellness, stay-at-work, or return-to-work, and importance of ongoing communication between all parties. Proactively involves strategic business partners as needed, such as, legal, rehab services, case managers to assist with return-to-work or stay-at-work. 
3. Authorizes payment of medical and wage loss benefits within payment authority.
4. Assigns, directs, and manages medical, rehabilitation, investigative and legal services pursuant to the respective business procedures, and or client service instructions and applicable state law.  This includes clear documentation in claim comments of facts, issues and plans.
5. Handles fatalities and catastrophic cases, such as paraplegia, quadriplegia, catastrophic head injury, major amputation, in the acute stage, and post-acute when appropriate, with guidance from technical experts and claims specialists.
6. Establishes initial and ongoing case reserves within authority level that accurately reflect file exposure in accordance with Company reserving guidelines relating to qualitative analysis and timing and/or client service instructions.  Recommends reserves for cases that exceed authority level. 
7. Communicates and educates the employer on case exposure/reserves and how reviews mitigation options. Communicates and partners with the reinsurer regarding case exposure/reserves, high expense items and issues which impact future costs.
8. Provides and documents strategy to bring cases to resolution per the respective business’s best practices, procedures and philosophy. 
9. Identifies, analyzes and resolves the majority of payment changes and errors on files.  When unable to resolve, actively seeks out and works with Claims Technical to learn for future application.
10. Manages data timely and accurately on files following state regulatory reporting requirements,   rating bureau reporting mandates and internal data needs.

Business Operations

1. Demonstrates the skill set to handle severe claims and is a resource to other team members handling similar claims.
2. Participates in discussions on file strategy. Reviews, documents and approves requests to increase reserves and/or settlements within their authority. 
3. Assists less experienced representatives in claim management, use of company resources and company services

What We will Love About you 

• Bachelor’s degree preferred.
• Four or more years of workers compensation lost time experience.
• Pursuit or attainment of a professional insurance designations (CPCU, ARM) preferred.
• Knowledgeable of state applicable Workers’ Compensation Act and its application to claims administration.
• Knowledge and skills in state regulatory reporting.
• Strong knowledge of medical terminology, anatomy and procedures.
• Awareness of related disability benefits.
• Understanding of insurance finance.
• Excellent customer service and interpersonal skills.
• Outstanding oral and written communication skills.
• Proven ability to effectively interact with a diverse group of customers and business units.
• Ability to assimilate, understand and analyze information from a variety of sources.
• Strong math skills.
• Strong skills in investigating, negotiating and settling claims.
• Strong problem-solving and decision-making skills.
• Strong computer skills (preferable in a Windows environment).
• Effective prioritization, organization and time management skills.
• Demonstrates positive teaming skills focused on team results.
• Ability to work on business premises when needed.

Work Environment and Physical Demands

Regular attendance is required. Work takes place in a semi paperless environment within an office setting, either on business premises or other remote location, using standard office equipment such as computers, phones, and copiers, which requires being stationary for extended periods of time.  While performing the duties of this job, the employee is regularly required to talk or hear. The employee frequently is required to stand; walk; use hands and fingers, handle or feel; and reach with hands and arms and work with close vision. This position requires the ability to occasionally lift office products and supplies, up to 20 pounds. Work is performed indoors with little to no exposure to extreme outdoor weather conditions.

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The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

The base pay posted is just one component of SFM’s total compensation package. The salary range listed represents the full compensation range for this position. Job title and starting pay will be based on the selected candidate’s relevant knowledge, skills, abilities and/or experience, and education, if applicable as well as internal equity with other employees in the same job classification.

Join us!

 SFM Mutual Insurance Company and each of its parent companies, subsidiaries and/or affiliated companies are Equal Opportunity/Affirmative Action Employers. All employment decisions are made without regard to race, color, religion, sex, national origin, age, sexual orientation, marital, familial, or veteran status, medical condition or disability, or any other legally protected classification.

 SFM Companies, EEO/AA Employers. SFM is a participant of E-Verify. Applicants have rights under Federal Employment Laws.