This is an excellent opportunity to be trained into the world of workers’ compensation claims adjusting. The Medical Claims Specialist is a junior role to the Workers Compensation Claims Adjusters. In this role you will handle light to moderate claims. Your role will allow indemnity adjusters time to focus on more in-depth and complex cases. Workers compensation adjusting is an intellectually interesting and professionally rewarding position that plays a critical role in the success of the company while positively impacting lives. Your strong negotiation and persuasion skills; high aptitude to learn and effectively apply medical and legal principles; and ability to thrive in a challenging and fast paced role are attributes we want on our team.
- Determine coverage and compensability for reported claims
- Accurately set reserves, ensuring that timely updates are made with claim developments
- Maintain compliance with regulatory deadlines, benefit calculations, state reporting, and benefit notices
- Achieve favorable settlements through timely identification of settlement opportunities; accurate settlement valuations; and effective negotiation practices
- Direct vendors such as field nurses, investigators, defense attorneys to positively impact claims outcomes
- Ability to comprehend and learn new workers’ compensation regulations while interpreting complex legal and medical documents.
- Strong verbal and written communication skills with the ability to effectively communicate with a broad audience of varying backgrounds, frequently conveying complicated information in a way easily understood by a layperson
- Working knowledge of Microsoft Word, Excel, with aptitude to learn other software programs
- A keen, logical mind and a strong aptitude for analytical thinking
- Strong oral and written communication skills
- Rock-solid honesty, openness, and ethical values
- Highly collaborative, ego-free work style; fit into a culture in which people genuinely enjoy working together
- Working knowledge of Microsoft Word and Excel and the ability to rapidly master specialized software programs
- Bachelor’s degree is a plus but not required