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Medical Claims Specialist

 

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.

 

RESPONSIBILITIES:

  • 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

 

REQUIREMENTS:

  • 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

 

QUALIFICATIONS:

  • 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