Job Description

This position is responsible for a variety of professional duties in handling workers’ compensation claims in Georgia for Georgia Power, along with handling claims in Georgia for Southern Company Services, Southern Power, and Southern Communications. The role includes investigating, analyzing, and managing claims; determining compensability; handling indemnity, medical, financial exposure, and payments; completing required state and federal filings; working with defense counsel on legal or litigation matters; and supporting subrogation, excess insurance, Subsequent Injury Trust Fund (SITF), and other claim-related processes.

Please Note:

This is a hybrid position with in-office presence expectation at 241 Ralph McGill Blvd, Atlanta, GA.

JOB REQUIREMENTS:

Education:

Required:

• High School Diploma

Desired:

• Associate Degree
• Bachelor's Degree

Related Work Experience:

Required:

1–3 years of experience in workers’ compensation, insurance, HR, claims administration, medical claims, or a related field. Knowledge of accepted industry standards and practices, or the ability and willingness to learn workers’ compensation claim handling standards, compliance requirements, systems, and processes through on-the-job training.

Preferred:

Additional workers’ compensation claims experience, including experience handling or supporting medical-only, lost-time, complex medical, litigated, or settlement-related claims. Prior experience in claims, insurance, HR, medical billing, healthcare administration, risk management, or a related environment is also preferred. Experience evaluating compensability, exposure, reserves, return-to-work opportunities, settlement strategy, and claim resolution options is beneficial and may support placement at a higher level within the posted range. Demonstrated ability to learn new processes quickly, take effective notes, follow procedures, and apply training to daily work.

Business Acumen:

• Demonstrates problem-solving skills and the ability to develop practical solutions in new, unique, or unfamiliar situations.
• Communicates clearly and professionally in writing, including drafting correspondence, documenting claim activity, and preparing claim-related communications.
• Exhibits excellent communication skills and works effectively in a collaborative team environment.
• Demonstrates a strong willingness and ability to learn workers’ compensation concepts, claim handling practices, compliance requirements, and internal processes through on-the-job training.
• Quickly learns new processes, documents key information through effective notetaking, and applies knowledge to daily work.
• Identifies, evaluates, and actively pursues reimbursement and recovery opportunities with appropriate guidance.
• Adapts quickly to evolving processes, systems, and workflows.
• Calculates, reviews, and analyzes claim financials, including estimated future reserving, with training and oversight as experience develops.
• Balances attention to detail with the ability to effectively manage an assigned caseload.
• Maintains comprehensive claim documentation, including detailed notes and clear action plans.
• Manages calendars, diaries, and plans of action to support timely claim handling and compliance with deadlines.
• Demonstrates a continuous learning mindset and adaptability as processes and business needs evolve.
• Available and responsive to after-hours calls on a limited, as-needed basis.
• Available to travel to offsite meetings, conferences, hearings, mediations, training opportunities, or other business needs as required.
• Builds and maintains strong, professional relationships with internal and external stakeholders, ensuring timely and appropriate responsiveness.
• Collaborates with internal teams and external partners to resolve issues, process claims efficiently, complete required documentation, and bring claims to timely resolution.

Functional Expertise:

• Partners with employees, leadership, Medical & Health Services, Safety, medical providers, vendors, and legal counsel to effectively manage and resolve claims.
• Determines compensability and manages claims in accordance with Georgia workers’ compensation laws, rules, and company policies.
• Collaborates with external defense counsel to investigate claims and evaluate compensability based on case-specific facts and circumstances.
• Manages or supports a broad range of claim types, which may include medical-only, lost-time, complex medical, controverted, catastrophic, death, and litigated claims.
• Applies professional judgment and seeks appropriate guidance when evaluating complex claim issues.
• Communicates with Payroll to ensure proper handling of indemnity offsets and salary-in-lieu payments.
• Calculates, analyzes, and manages claim financials, including historical spend, exposure evaluation, future reserve estimates, and settlement-related financial considerations.
• Ensures timely and accurate processing of payments, including indemnity, medical, legal, and related expenses.
• Identifies and proactively pursues claim resolution opportunities, including return-to-work strategies, benefit management, settlements, and appropriate claim closure or benefit discontinuation.
• Evaluates claims for cost containment opportunities while ensuring appropriate and quality medical care.
• Coordinates reimbursement and recovery efforts, including excess insurance, Subsequent Injury Trust Fund, and subrogation opportunities.
• Maintains accurate and detailed claim documentation, including notes, diaries, action plans, and supporting information within claim systems.
• Ensures compliance with all state and federal reporting requirements, including Georgia State Board filings, Medicare Section 111 reporting, and CMS requests.
• Supports required annual filings, including reporting for the State Board of Workers’ Compensation and the Self-Insured Guaranty Trust Fund.
• Coordinates Medicare Set-Aside reporting and funding and facilitates arrangements and communications, with guidance as needed.
• Manages vendor setup processes, including requesting W-9s and obtaining billing information for payment processing.
• Supports medical management activities, including bill review approvals, pharmacy benefit management requests, and processing of employee reimbursements, including mileage and out-of-pocket expenses.
• Utilizes automation tools, including Power Automate, to support and streamline workflows where appropriate.
• Builds and maintains strong working relationships with external vendors, ensuring timely communication, responsiveness, and issue resolution.
• Demonstrates the ability to quickly learn and effectively utilize claim systems and business applications, including Assure Claims, ICMS II, Oracle, Mobi, Medicare Section 111 reporting tools, third-party medical and pharmacy platforms, and Microsoft 365 applications, with the expectation of ongoing learning as systems and processes evolve.
• Serves as a cross-trained resource for processes related to Panel of Physicians, Medicare Section 111 reporting, third-party discovery requests, and other administrative tasks.
• May serve as a resource to other team members by sharing knowledge, supporting process consistency, and assisting with claim-handling questions.

Litigation:

• Participates as Company Representative for claims, including providing testimony at hearings, depositions, mediations, and other legal proceedings, with training and preparation as needed.

• Partners closely with defense counsel by providing timely documentation, claim updates, and case strategy support.
• Prepares or supports settlement evaluations for management review and participates in negotiations as appropriate.
• Evaluates claims for closure opportunities and develops resolution strategies.
• Negotiates settlements with pro se claimants or supports counsel with requests needed to finalize settlement documentation and agreements, as appropriate.
• Coordinates subrogation efforts with motor vehicle insurers and legal representatives when third-party liability exists.

• Communicates with opposing counsel, when appropriate, to support timely resolution and cost management of legal expenses.