Key responsibilities
FNOL Processing (Voice & Written):
- Process Workers Comp first notice of loss reports submitted via phone, email, or web; complete claim questionnaires in Origami. Process FNOL intake for CorVel jurisdictions (AK/NM/NV/OR) or Sirius Point policy term); enter claim in Origami and provide abstract with policy documentation.
- Provide FNOL overflow support during high call volume periods when queue exceeds capacity
- Verify policy coverage based on date of injury via email template; provide policy information and documentation to requesting parties
General Inquiries (Voice & Written):
- Handle inbound calls and emails from insureds and involved parties with general questions about whether an incident could or should be reported (no claim established); escalate to adjuster as needed
- Provide claim status updates within defined scope; route complex questions to customer care advocates or adjusters as appropriate
- Respond to payment status inquiries including check status, direct deposit status, and payment confirmation; coordinate with finance team as needed
- Handle medical provider communications requesting explanation of review (EOR), payment status, or authorization status
- Triage partner and agent inquiries regarding jurisdictional nuances to the appropriate adjudication team
- Triage treatment authorization calls and emails to the appropriate adjuster or Team Lead
- Provide medical panel information to insureds via phone or email
Data Entry & Administrative Support:
- Review and address pre-paid envelope additions or mailing address corrections on auto-mailed documents
- Add medical vendors to Origami for payment expediting when Corvel bills do not match existing records
- Enter W9 information to confirm vendor or firm is in system for payment issuance
- Create vendor records and involved party entries for payment purposes (child support, attorney, state board)
- Process involved party setups, W9 requests for new payees, follow-up, W9 data entry, and non-taxable entity configurations
Document Management:
- Review scanned physical mail from PO Box in Filebound exception queue; send to claim via SFTP or triage appropriately
- Review and redistribute documents that landed on incorrect claims
- Respond to ad hoc and recurring loss run report requests from leadership and agencies
- Locate policies associated with FNOLs where no policy was initially linked; escalate to Team Lead via Slack for adjuster assignment when no policy is found.
Qualifications & Desired Skills
Knowledge:
- Workers Comp fundamentals: injury types, body parts, employment status, medical treatment, DOI/DOL, claimant, insured, exposure, jurisdiction
- FNOL procedures for voice and written channels using established scripts, templates, and system prompts
- Basic policy components: policy number, insured name, coverage dates, jurisdiction
- Document types (medical records, correspondence, legal documents) and appropriate routing destinations
- Issue identification and escalation protocols for complex coverage issues, legal involvement, or serious injuries
Skills:
- Attention to Detail: Accurately captures and verifies information in real-time; implements quality checks before submission
- Communication (Verbal & Written): Uses clear, professional language following call scripts; responds to emails using established templates with claim-specific customization
- Customer Service: De-escalates frustrated callers; provides empathetic, timely responses across voice and written channels
- Timeliness: Manages call handle time and written SLAs; maintains steady queue workflow pace
- Multitasking: Navigates multiple systems simultaneously (Origami, Salesforce, Filebound, Five9) while maintaining conversation quality
- Organization: Manages multiple task queues (FNOL, email, phone, document review) prioritized by SLA deadlines
- Adaptability: Adjusts to procedure updates with training; handles new document types with guidance; shifts between voice and written work as needed
- Technology: Proficient navigation of Origami, Five9, Salesforce,Filebound, and Google Suite following established workflows
Qualifications:
- High school diploma or GED equivalent required; two to four years of customer service, administrative, or back office experience preferred
- Previous experience in claims processing, insurance operations, or a BPO environment is highly desirable
- Familiarity with Workers Compensation policies and regulatory requirements is a plus
- Proficiency in Salesforce, Origami, or similar CRM/claims management systems is a plus
- Strong attention to detail with the ability to accurately transcribe and route information across systems
- Ability to handle high call and task volume simultaneously while maintaining quality and composure
- Excellent verbal and written communication skills with a professional, empathetic customer service approach
