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Claims Service Representative
2 months ago
The Claims Service Representative is responsible for providing exceptional customer service to workers, employers, and other stakeholders by resolving claim-related inquiries and issues in a timely and professional manner.
Key Responsibilities:- Respond to and resolve claim-related telephone inquiries and issues in a professional and courteous manner.
- Create new claim files, ensure Workers Compensation coverage, and manage each inquiry to a resolution that provides for customer satisfaction and meets organizational standards and objectives.
- Use effective listening and questioning techniques to determine each customer's need(s); identify, evaluate, and determine alternatives to problem solve.
- Follow established procedures to create new claim files, input data, search the database, and verify and collect information by calling for or requesting reports from injured workers, employers, and healthcare providers.
- Notify the appropriate internal parties at the time of reporting of a serious accident or fatality.
- Follow department standards for gathering, reviewing, and assessing information to establish Workers Compensation coverage for new claims, communicating decisions to affected parties where appropriate, and referring to the Supervisor or Assessment Services in cases where further action is necessary.
- Accept no time loss claims (Complexity A) within defined parameters. Claims requiring further investigation or approval are forwarded to Adjudicators for review.
- Utilize each inquiry as an opportunity to address customer concern(s) and anticipate future needs, reviewing outstanding or future claim file tasks when appropriate.
- Identify workers in crisis and refer to an appropriate WCB resource.
- Review the claim file and approve medical expenses within specified guidelines and authority levels. Manage claim owner-approved wage loss issues. Refer inquiries that are highly unusual, complex, or above authority levels to the appropriate Adjudicator or Case Manager.
- Update claim files as part of each call; clearly document customer communication, including any information gathered, entitlement decisions made, actions taken, and claim tasks created.
- Completion of a two-year diploma in a related discipline (Business Administration)
- Minimum two years' experience interpreting and applying processes and procedures to manage and resolve customer inquiries/concerns
- Typing speed of 35 (error rate less than 5%)
- Knowledge of customer service principles and practices
- Proficiency in the use of personal computers and software in a Windows environment
- Excellent customer service skills, including the ability to manage potentially confrontational situations with tact and diplomacy
- Well-developed verbal and written communication skills to deal with internal and external stakeholders
- Ability to interpret and apply processes and procedures, including those related to WCB Adjudication and Case Management
- Ability to obtain, assess, and evaluate information through claim file review, listening, and/or questioning to problem solve and support decision making
- Ability to perform detailed and accurate work in a fast-paced environment
- Ability to work independently and as part of a team
The Workers Compensation Board of Manitoba promotes safety and health in Manitoba workplaces and aims to help prevent and reduce the occurrence of workplace injuries and disease.
Working with its partners, the WCB promotes safe and healthy workplaces, facilitates recovery and return to work, provides compassionate and supportive compensation services for workers and employers, and ensures responsible financial stewardship.
