State Workers' Insurance Fund Claims Representative

Claims Representative

Are you ready to take the next step in your career? If so, consider joining the Department of Labor & Industry, State Workers' Insurance Fund (SWIF) as a Claims Representative. This position gives you the opportunity to investigate, process, and manage reported work-related claims or injuries for employees of policy holders covered by the State Workers' Insurance Fund for the purpose of determining compensability. If you are an analytically minded professional with a keen eye for detail, we need you on our team!

As a Claims Representative, your focus will be on completing investigations for reported work related or injury incidents or claims; processing acceptance or denial within 48 hours of receiving the assignment. The investigation must include consideration of the course and scope, employment relationship and may include, but should not be limited to vehicle accident, coming and going, if appropriate to the assigned office, firefighter affiliation, undocumented worker, misclassification, and all other information that is necessary to determine compensability of the present claim. You will have the opportunity to monitor and control all aspects of the claim to conclusion in accordance with established authority and procedure. You can expect to handle all aspects of minor disability or lost time claims with closed periods of disability or anticipated lost time of less than eight weeks.

Additional duties to include but not limited to :

• Making determinations to identify potential fraud, documenting and reporting all suspected fraud to the SWIF fraud investigator and supervisor
• Identifying and making recommendations to supervisor when identified excess use of Physical Therapy or Durable Medical Equipment supplies have been ongoing for an extended or excessive period of time
• Ensuring claim intake data is complete and accurate including but not limited to claimant data, employer data, NAICS and incident information
• Contacting appropriate parties related to the reported claim including claimant, employers, doctors, hospitals, and witnesses to determine eligibility for workers' compensation benefits

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