Senior Claims Representative

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🔥 8 minutes ago

🌽 Illinois, Iowa, +4 more states – Remote

🌽 Illinois – Remote 🌾 Iowa – Remote 🌪️ Kansas – Remote 🌾 Nebraska – Remote 🏰 Missouri – Remote 🎸 Tennessee – Remote

⏰ Full Time

🟠 Senior

📋 Claims Specialist

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Dayforce

WebsiteLinkedInAll Job Openings

5001 - 10000 employees

👥 HR Tech

☁️ SaaS

🏢 Enterprise

💰 $1G Post-IPO Debt - Dayforce on 2024-03

HR Tech • SaaS • Enterprise

Dayforce is a cloud-based human capital management (HCM) platform that provides payroll, workforce management, HR, benefits administration, talent management, and scheduling tools for employers. Delivered as a Software-as-a-Service solution (originally developed by Ceridian), Dayforce is used by mid-market and enterprise customers to unify HR processes, time and attendance, and payroll in a single system.

📋 Description

• Manage highly complex claims involving significant financial exposure, legal intricacies, and extended life cycles. • Conduct advanced investigations into coverage and compensability, including nuanced statutory interpretations. • Oversee medical case management for catastrophic injuries and lifetime care needs. • Review and authorize large or complex medical bills, negotiating adjustments to control costs. • Develop comprehensive RTW strategies in collaboration with policyholders, legal counsel, and vocational consultants. • Ensure precision in benefit calculations for high-exposure claims, addressing tax and compliance risks. • Strategically deploy investigative efforts aligned with broader claims strategy. • Lead investigations into complex fraud cases and collaborate with the Special Investigations Unit. • Conduct subrogation analysis and negotiate with third-party insurers or attorneys for maximum recovery. • Partner with legal teams to negotiate complex settlements and manage litigation processes. • Oversee Medicare compliance initiatives, including Medicare Set-Asides and CMS engagement. • Identify opportunities for structured settlements and lead negotiations. • Produce strategic reports on high-profile claims to guide management decisions. • Maintain system data integrity and prepare claims for Corporate Plan of Action meetings. • Lead cross-departmental efforts to improve claims handling and risk management. • Resolve escalated customer service issues and support high-value accounts. • Participate in workflow improvement initiatives and committees. • Mentor and coach junior and intermediate adjusters. • Review escalated claims and provide actionable feedback. • Support workforce development and succession planning.

🎯 Requirements

• Bachelor’s degree in business or related field preferred, or equivalent industry experience. • 7–10 years of claims handling experience, with high exposure to Workers’ Compensation. • Associate in Claims (AIC), AIM, or CPCU designation preferred or ability to obtain. • Texas All-Lines license preferred. • Valid driver’s license required.

🏖️ Benefits

• Health Plans: Medical, Dental, and VisionIncludes fertility benefits, fully paid preventative care, and adult orthodontia. • Employer-Paid Life and Disability Benefits:Life Insurance (3x base salary), AD&D, Short and Long-term Disability. • Wellness and Recognition Program: Employer-paid incentives for employees and spouses. • Flexible Spending Account and Dependent Care options • Health Savings Account: Generous employer contribution. • Time Away from Work:Generous PTO, 11 Holidays + 4 Early Releases, 16 Hours Volunteer Time Off, 20 Days Paid Parental Leave, Marriage, Bereavement, and Jury Duty leave. • Employee Assistance Programs • 401k Retirement Plan: Employer match and profit sharing. • Adoption Assistance and Tuition Assistance