Claims Representative II

Responsibilities

• Strategically manage indemnity claims and claim-related issues to cost-effective resolution
• Investigate accident and injury circumstances to determine compensability
• Proactively manage open claims including medical case management, disability, and litigation
• Coordinate resources such as legal, medical case managers, and return-to-work consultants
• Communicate proactively with policyholders, injured workers, medical providers, and attorneys
• Facilitate early return to work for injured workers
• Evaluate claims for settlement and negotiate with injured workers or counsel
• Set and maintain accurate reserves by reviewing medical records and predicting future treatment costs
• Prepare for and testify at settlement conferences and hearings
• Review and authorize medical bill payments

Requirements

• 1 or more years of experience managing workers’ compensation claims
• Proven proficiency in resolving medical claims
• Ability to apply Colorado jurisdictional requirements
• Strong statutory understanding and basic calculation skills

Benefits

• Diverse medical, dental, and vision offerings
• 20 paid days off in the first full year plus 9 paid holidays
• Wellness programs including company-paid fitness facilities
• Professional development opportunities
• Paid time off for volunteering via Pinnacol in Action
• Quarterly incentive up to 12 percent of annual base salary

About the Company

Pinnacol Assurance provides workers’ compensation protection to Colorado employers and employees, focusing on innovation, compassion, and community impact.