Dollar General

Dollar General, a discount chain store, stands to serve their customers and its community. Headquartered in Goodlettsville, Tennessee, Dollar General Corporation celebrates 75 year

Workers Compensation Claims Representative

Location

United States

Posted

2 days ago

Salary

5 - 67.7K / year

Seniority

Mid Level

No structured requirement data.

Job Description

Workers Compensation Claims Representative

Dollar General

Role Description Responsible for managing workers’ compensation claims by investigating reported incidents, determining compensability, coordinating medical and disability management, evaluating claim exposure, and ensuring compliance with state laws and reporting requirements. This role partners with injured employees, store personnel, medical providers, attorneys, case managers, and other service providers to support return-to-work efforts, manage benefits, control claim costs, develop strategic resolution plans, and maintain compliance with applicable workers’ compensation regulations and licensing requirements. - Conduct interviews with injured employees, store personnel, and medical care providers within 24 hours of receiving a reported incident. Utilize complex problem-solving, critical-thinking, and organizational skills to evaluate compensability and effectively manage claim assignments. Maintain communication with appropriate parties throughout the life of the claim to support proper medical and disability management and resolution. (20%) - Utilize professional experience and investigative skills to evaluate claim exposure and develop action plans related to medical management, disability management, and claim resolution. (20%) - Proactively coordinate and communicate with physicians, injured employees, and store personnel regarding light-duty or full-duty return-to-work opportunities, payment of appropriate benefits, and utilization of in-house and field nurse resources for medical and disability management. (15%) - Evaluate requests for medical care to determine causation and relatedness in compliance with state requirements. Timely assess and pay medical and indemnity benefits in accordance with applicable laws and complete all required state reporting. (15%) - Coordinate and communicate with service providers, including defense attorneys, medical case managers, and private investigators, to minimize claim expenses and maximize outcomes. (10%) - Develop and maintain a proactive strategic action plan throughout the life of each claim. Resolve claims efficiently and provide recommendations for claim resolution in accordance with best practices and state requirements. (10%) - Maintain working knowledge of multiple state workers’ compensation laws and regulations and maintain all required state licensing. (10%) Qualifications - Extensive claim handling experience with emphasis on workers’ compensation. - Possess complex problem solving and strong decision-making skills. - Strong organizational skills and the ability to prioritize. - Customer service oriented and works well in a team environment. - Excellent written and verbal communication skills. - Must be detail oriented and able to meet deadlines. - Ability to handle confrontational situations in a mature and professional manner. - Working knowledge of medical and legal terminology. - Working knowledge of Microsoft Office programs. - Must have extensive insurance claims background and experience with emphasis on workers’ compensation. - 1-2 years of related experience preferred. College degree preferred but not required. Equal education and experience may be considered. Requirements - The compensation for this role is firm at 67,743, a 5% company performance bonus and remote.

Related Categories

Related Job Pages

More Claims Specialist Jobs

FUJIFILM logo

Contract Management Specialist

FUJIFILM

FUJIFILM is a publicly traded, multinational photography and imaging company with global headquarters in Tokyo, Japan and regional headquarters in Valhalla, New

Role Description We are hiring a Contract Management Specialist- Commercial Sales. The Contract Management Specialist- Commercial Sales will acts as a single point of contact for Sales, Procurement, Pricing, Quality, Finance, Commercial Operations, and Legal to ensure customer contracts are accurate, complete, and executed efficiently. Responsibilities: - Contract Review & Coordination: - Coordinate the review of contract drafts and templates with functional stakeholders to ensure alignment with business deliverables, pricing, incentives/rebates, service levels, and operational requirements. - Ensure all required sections of contracts are reviewed and approved by the appropriate teams. - Facilitate internal review cycles and track feedback, revisions, and approvals. - Develop a working understanding of contract terms and language to identify potential issues and ensure clarity before escalation. - Negotiate Support (Business-Focused): - Partner with Sales, Pricing, and Commercial teams to support contract negotiations related to business terms, pricing structures, and service commitments. - Ensure negotiated terms are accurately reflected in contract documents. - Serve as a liaison between business stakeholders and Legal during negotiations. - Risk Identification & Issue Escalation: - Identify potential contractual risks, inconsistencies, or gaps from a business and operational perspective. - Escalate complex or high-risk issues to Legal and Commercial leadership as appropriate. - Support risk mitigation efforts by ensuring contract terms align with internal policies and operational capabilities. - Contract Administration & Lifecycle Management: - Maintain contract records, databases, and version control throughout the contract life cycle. - Track contract milestones, renewals, expirations, amendments, rebates, growth incentives, and key deliverables. - Ensure executed contracts are properly stored and accessible in the contract management systems or other related systems. - Support audit readiness by maintaining accurate and complete contract documentation. - Stakeholder Collaboration: - Partner closely with Procurement, Pricing, Quality, Commercial Operations, Sales, Finance, and Legal to ensure timely contract review, renewals, and execution. - Act as a central point of contact for contract status, questions, and coordination. - Promote accountability across stakeholders for completing required contract actions. - Performance Monitoring & Reporting: - Monitor contract compliance with key terms, milestones, and obligations. - Generate reports and dashboards on contract status, cycle times, renewals, spending, and performance metrics. - Provide visibility to management on contract pipeline, risks, and execution status. - Process Improvement & System Management: - Develop and enhance contract workflows to improve efficiency, consistency, and cycle time. - Recommend improvements to contract templates, review processes, and tools. - Manage and maintain the contract management system and other related systems. - Support standardization and best practices in contract management across the organization. Qualifications - Bachelor’s degree in Business, Finance, or related field. - 3+ years of experience in contract management. - Strong understanding of contract structure and commercial terms (non-legal). - Excellent organizational, coordination, and communication skills. - Ability to manage multiple contracts and stakeholders simultaneously. - Preferred experience working cross-functionally with Legal, Sales, Finance, Procurement, or Quality teams. - Preferred familiarity with contract management systems (CLM tools). - Preferred experience supporting negotiations or complex commercial agreements. - Preferred Life Sciences, biotech, pharmaceutical, or regulated industry experience. - Must be fluent in the English language to interact with stakeholders. Requirements - Salary range for this position is $76,900 - $100,200. - Compensation for the successful candidate will depend on various factors (e.g., qualifications, education, prior experience, location, etc.). Benefits - Medical, Dental, Vision - Life Insurance - 401k - Paid Time Off

United States
$76.9K - $100.2K / year
Skyward Specialty Insurance logo

Senior Claims Adjuster, Professional Liability

Skyward Specialty Insurance

We spark potential by smartly shifting risk to a safer place.

Full TimeRemoteTeam 501-1,000Since 2007H1B No Sponsor

• Handle claims nationwide reported under primary and excess Miscellaneous Professional E&O, including coverage analysis, investigation, liability and potential exposure analysis, and the development and implementation of resolution strategies. • Effectively and promptly communicate with insureds, agents, brokers and underwriters regarding claim status and handling. • Analyze coverage and prepare coverage letters on complex matters with the guidance of in-house coverage counsel. • Manage claims in litigation, including strategizing with defense counsel and experts on defending such. • Set timely and accurate indemnity and expense reserves and reevaluate/update reserves appropriately based upon claim development. • Negotiate settlements and attend mediations, arbitrations and trials as appropriate. • Manage and control Loss Adjusting Expenses incurred by counsel, experts and vendors. • Present, analyze and make recommendations on reserves, coverage and strategy. • Comply with state guidelines for Good Faith Claims Handling. • Prepare required Large Loss Reports and Trial Alerts. • Participate in professional liability industry organizations and instructional seminars for CE and CLE credits. • Effectively communicate and interact with all internal and external stakeholders to promote a professional and positive business environment so that Skyward’s goals and objectives are being achieved. • Other duties as may be required due to change, growth, and continuous improvement.

United States
$110K - $140K / year
Superlanet logo

PB & Claims Analyst

Superlanet

Advisory, Staffing, and Multi-State Employer of Record Solutions for Clinicians, by Clinicians.

ContractRemoteTeam 51-200Since 2017H1B No Sponsor

• Design, build, and support the Epic PB Admin and PB Claims applications. • Analyze business requirements and optimize Professional Billing and claims workflows. • Troubleshoot production issues and provide ongoing application support. • Participate in testing, upgrades, implementations, and go-live support. • Collaborate with operational, IT, and vendor teams to deliver effective solutions.

Texas
$60 - $83 / hour
Cover Genius logo

Licensed Claims Adjuster

Cover Genius

Cover Genius protects the global customers of the world’s largest digital companies, including Hopper, Skyscanner, Ryanair, Intuit, ShipRush, SeatGeek, and Descartes. The company

Role Description We are seeking a Licensed Claims Adjuster who will be responsible for adjudicating regulated insurance claims within the Digital Commerce vertical. This role sits at the intersection of regulatory compliance, policy interpretation, and operational performance. The position combines traditional claims handling responsibilities with elevated authority to handle regulated and complex files requiring state licensure. This is not a purely administrative role nor a purely customer service role, but a specialized position designed to strengthen compliance, technical accuracy, and financial risk controls across the claims function. You will collaborate closely with the Claims Manager and cross-functional stakeholders to ensure timely, compliant, and well-reasoned determinations on complex and/or high-exposure claims related to electronics, appliances, furniture, and other retail goods. Combining sound coverage judgment and disciplined documentation, you will help safeguard claim quality while maintaining operational efficiency. Key Responsibilities - Claims Adjudication: Manage end-to-end handling of regulated insurance claims, including investigation, coverage analysis, formal determination, claim actions, communications, and payment issuance related to retail, electronics, appliances, and furniture within defined service-level agreements (SLAs). - Claim Determination: Interpret policy language and underwriting guidelines to issue compliant, well-reasoned coverage decisions in accordance with applicable state insurance regulations. - Complex & Escalated Files: Handle high-exposure, sensitive, or escalated claims requiring licensed authority and independent judgment. - Regulatory Compliance: Maintain active state licensure and ensure adherence to jurisdictional insurance laws, DOI requirements, and internal governance standards. - Fraud & Risk Identification: Identify potential fraud indicators and escalate appropriately in line with company protocols and fraud thresholds. - Customer Communication: Respond to customer inquiries via phone, email, or chat regarding claim status, documentation, and coverage decisions, communicating complex determinations clearly and professionally. - Documentation & Audit Readiness: Ensure all required documentation is collected, reviewed, and accurately recorded in the claims system to support audit integrity and regulatory compliance. - Quality & KPI Performance: Maintain high levels of claim accuracy and timeliness in alignment with business, team, and individual performance metrics. - Technical Support & Collaboration: Provide guidance to non-licensed assessors on policy interpretation and complex files; collaborate with Claims, Support, and Compliance teams to ensure efficient and consistent resolution. - Process Improvement: Identify and recommend operational improvements to enhance efficiency, reduce leakage, and strengthen internal controls within the Digital Commerce vertical. Qualifications - Active U.S. state Adjuster License in good standing (multi-state or reciprocal licenses preferred). - 2+ years of experience handling regulated insurance claims, ideally across electronics, appliances, or furniture; financial/credit card/NAC programs a plus. - Strong knowledge of digital commerce and retail supply chain operations, including warranty and service contract programs. - Familiarity with repair networks and ability to coordinate repair assessments and turnaround processes. - Solid understanding of jurisdictional insurance regulations and fair claims handling practices. - Strong analytical and investigative skills with sound judgment in evaluating documentation and determining coverage. - Excellent written communication skills, particularly in drafting clear, defensible claim determinations. - Experience working in a KPI-driven environment with accountability for quality and turnaround time. - Ability to operate independently in a fully remote environment with strong organizational and time-management skills. - Proficiency in claims management systems and digital documentation platforms. - Collaborative mindset with the ability to provide technical guidance and support to junior or non-licensed team members. - Bachelor's degree in a relevant field; a postgraduate degree and/or record of academic achievement is also desirable. What you will have - Investigative rigor with ability to verify claims through documentation and repair assessments. - High attention to detail, ensuring accuracy in case handling and valuation. - Customer-first approach, resolving escalations with empathy and professionalism. - Strong analytical skills to spot claim trends, systemic risks, and recurring product issues. - Confident, timely decision making in complex or high-value cases. - Clear communication and collaboration skills with retail partners, repair networks, and compliance. Benefits - Flexible Work Environment - our team is remote. - Global company, with the opportunity to work from any of our offices for 4 weeks a year. - Work with like-minded people who are passionate about both the work we're doing and giving back. - Our CG Gives programs enable us to all become philanthropists through our peer recognition and rewards system.

United States