Workers' Compensation Claim Professional — FT

SFM Companies (SFM Mutual Insurance)
August 29, 2023
Sioux Falls (Remote), SD
Job Type


As a WORKERS' COMPENSATION CLAIMS PROFESSIONAL, you will use your claims handling experience to help people who were hurt on the job get better. You will work on a team that includes Nurses, Loss Prevention Reps and Underwriters. You will help prevent and reduce the impact of injuries and assist your team in managing your assigned accounts. Your job title will be based on your work experience and background. Persons with experience handling SD Workers' Compensation Claims are encouraged to apply and will be given strong consideration.

At SFM, our proprietary work comp computer system helps you be successful in the work that you do. Our claim counts are manageable, allowing you to be more strategic in how you handle your claims and have a "life outside of work!" Your job duties include conducting investigations, calculating lost wages, and managing claims in accordance with state workers' compensation statutes and company best practices. You will handle claims from "cradle to grave", and depending on the role, mentor others as needed.

At SFM, our mission is to deliver the best customer service to both the injured worker and employer so that claims are handled with a successful resolution. Working collaboratively in a multifunctional team is key to being successful in this role. SFM offers a hybrid work environment or remote work, depending on your location, and flexible work schedules.

You can work in Minnesota, Wisconsin, Iowa, Nebraska, South Dakota, Kansas or Missouri. Some travel to the Corporate Headquarters in Bloomington, MN may be needed. Actual claims handling experience is needed. If this sounds like a place you could thrive, then we want to know more about you!

Salary Range DOE: $65,000.00 to $105,000.00 per year

Our benefits include:

  • Affordable Medical, Dental, Vision Insurance, HSA, FSA
  • Flexible hybrid work environment
  • Traditional and Roth 401(k) plans with company match
  • Company contributions to help pay off student loans
  • Monthly home internet allowance
  • Free life insurance, STD & LTD
  • Opportunities for annual gainshare bonus
  • Pet insurance
  • Generous PTO
  • 9 paid holidays
  • Paid parental leave
  • Annual company-wide volunteer day
  • Discounts on gym memberships, fitness apps and weight loss programs
  • Adoption financial assistance

What You Will Be Doing:

  • Makes timely contact with all parties to a claim to gather necessary information to determine liability and fulfill regulatory, contractual, and internal reporting requirements. Applies the workers' compensation statute and case law to facts to determine compensability. Uses internal resources as required by company best practices or client servicing instructions for questionable compensability decisions and subrogation or fraud issues.
  • Sets expectations with the injured worker and employer of wellness, stay-at-work, or return-to-work, and importance of ongoing communication between all parties. Involve strategic business partners, to assist with return-to-work or stay-at-work.
  • Authorizes payment of medical and wage loss benefits within payment authority.
  • Assigns, directs, and manages medical, rehabilitation and legal services pursuant to the respective business's procedures, client service instruction and applicant state law. This includes documentation in claim comments of facts, issues and plans.
  • If needed, attends field visits of policyholders, agents and injured workers, with assistance as needed. May include travel.
  • Establishes initial and ongoing case reserves within authority level that accurately reflect file exposure in accordance with Company best practices and client reserving guidelines relating to qualitative analysis and timing. Recommends reserves for cases that exceed authority level.
  • Communicates and educates the employer on case exposure/reserves and how to mitigate the exposure. Communicates and partners with the reinsurer regarding case exposure/reserves, high expense items and issues which impact future costs.
  • Provides and documents strategy to bring cases to resolution per SFM best practices, procedures and philosophy. This is evidenced by documenting files in claim comments with 1) timely action plans; 2) pertinent facts and issues for roundtable discussions; and 3) analysis of settlement exposure, including, with assistance, the use of spreadsheets.

What We'll Love About You:

  • Bachelor's degree preferred.
  • Six months or more of workers compensation lost time experience.
  • Knowledgeable of state applicable Workers' Compensation Act and its application to claims administration.
  • Knowledge and skills in state regulatory reporting.
  • Strong knowledge of medical terminology, anatomy and procedures.
  • Understanding of insurance finance.
  • Excellent customer service and interpersonal skills.
  • Good oral and written communication skills.
  • Ability to effectively interact with a diverse group of customers and business units.
  • Ability to assimilate, understand and analyze information from a variety of sources.
  • Strong math skills.
  • Developing skills in investigating, negotiating and settling claims.
  • Problem-solving and decision-making skills.
  • Acts as a mentor to others when requested.
  • Strong computer skills (preferably in a Windows environment.)
  • Effective prioritization, organization and time management skills.
  • Demonstrates positive teaming skills focused on team results.

Physical Requirements:

Regular attendance is required. Work takes place in a semi paperless environment within an office setting, either on business premises or remote location, using standard office equipment such as computers, phones, and photocopiers, 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, and maintain concentration and focus. 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. Travel as needed.

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. .

About SFM

SFM is unique in that we are small enough that your voice is heard but has all the benefits and perks of a larger employer. We value your opinion, help you reach your goals, and make it easy for you to maintain work-life balance. SFM is committed to creating the best work environment and believes that our exceptional and motivated employees are our greatest strength.

Join us!! Click "Apply" Now


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.

Drop files here browse files ...

Related Jobs

Distribution Center Supervisor   Beresford, SD new
September 27, 2023
Warehouse Worker II   Beresford, SD
September 20, 2023
September 1, 2023
September 1, 2023