Medical-Only Claim Representative-Workers' Compensation

Location: Iowa (Remote) | Full-Time

Pay: $26.09 to $36.53 per hour

Ranked #8 Top Workplace – Midsize Employer, MN

About the Role:

At SFM, the Medical Only Claims Representative investigates workers' compensation claims to assess whether medical treatment for injured workers is compensable. You will play a critical role in evaluating workplace injuries and assist  employees and employers throughout the claims process.  This position involves reviewing the validity of claims, gathering  relevant medical documents and collaborating with the employer and healthcare providers to ensure that the injured workers medical expenses are paid in accordance with the State's guidelines and SFM’s best practices.  The goal is to provide a successful and  efficient resolution of the claim. You will use your strong communication skills and critical thinking skills, while focusing on delivering excellent customer service to all parties involved in the claims process.  Helping people, and making a difference in someone's life  is a big part of the responsibilities for this job, as is working collaboratively within a multifunctional team.  That team environment is what makes SFM unique.   SFM is committed to providing you with the training you need to be successful and  help you develop your skills to grow professionally.   This position is a great way to jump start your career at SFM and learn the ins-and-outs of claims handling. Applicants must live in Iowa. 

What You’ll Do:

1. Work on a multifunctional team, manage medical-only claims as assigned and determines and communicates findings to the injured worker/ employer, while partnering with medical providers and other key stakeholders.
2. Investigate claims which involves gathering all relative information for the purpose of determining the validity of the claim.
3. Approve or deny medical bills associated with the claim, which involves setting/verifying adequate reserves, reviewing for compensability and application of any applicable treatment parameters.
4. Escalate claims to lost time claims representatives when appropriate if a claim is expected to exceed reserve limits, or involves a claim for indemnity benefits or disputes unable to be resolved.
5. Apply business unit policies, practices and procedures and provide superior customer service to policyholders, agents, injured workers and team members and ensures compliance of state laws and requirements.
6. Regularly interacts with team members, policyholders, agents, legal counsel, medical providers and injured workers to achieve timely and fair resolution of claims while delivering excellent customer service.
7. Documents all actions taken during the claims process.

What We’ll Like About You:

• Bachelor's degree preferred.
• Associate’s degree or two years’ business experience, preferably in an insurance environment, medical office, or customer service environment is acceptable.   
• One or more years handling casualty claims, PIP claims or workers’ compensation claims, preferred.
• Must be detailed oriented.
• Excellent customer service skills, and the ability to work well within a team environment.
• Excellent problem solving and decision-making skills.
• Strong verbal and written communication skills.
• Ability to conduct research, assimilate and interpret complex information from a variety of sources.
• Ability to work in a fast-paced environment and manage multiple projects and deadlines with limited supervision.

 Why You’ll Love Working Here

We want your work life to feel balanced, rewarding, and supported. Here are just a few of the benefits SFM offers:

• Comprehensive medical, dental, and vision coverage (plus HSA/FSA options).

• Significant Cash Benefit if You Opt Out of Our Health Plan

• Flexible hybrid work environment.
• 401(k) with both Traditional and Roth options + company match.
• Contributions toward student loan repayment.
• Generous PTO, 9 paid holidays, and paid parental leave.
• Monthly home internet allowance.
• Free life insurance, short-term & long-term disability coverage.
• Incentive bonus opportunities.
• Adoption financial assistance.
• Pet insurance.
• Annual company-wide volunteer day.
• Discounts on gyms, fitness apps, and wellness programs.

Who We Are

SFM is the leading workers’ compensation insurer in Minnesota, with a growing presence across the Midwest. We’re proud to be recognized as a Top Workplace (#8 midsize employer in MN) thanks to our supportive culture, commitment to our employees, and focus on doing what’s right. Learn more by clicking here.

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. #SFM

 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.

SFM Mutual Insurance Company and each of its parent companies, subsidiaries and/or affiliated companies are Equal Opportunity/Affirmative Action Employers. SFM provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, status with regard to public assistance, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

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