Claim Representative, Medical Only

Job Summary

The Medical Only Claim Representative is responsible for claims handling of designated medical only claims and provides support to claim staff. This position may serve as a training ground for promotion to an intermediate level claim position.

Responsibilities

• Set up and manage medical-only claim files in accordance with corporate claim standards and applicable laws
• Establish reserves and provide reserve recommendations within authorized levels under direct supervision
• Review and approve medical and miscellaneous invoices on designated claims; negotiate disputed bills or invoices under supervision
• Request and monitor medical treatment in accordance with corporate claim handling standards
• Summarize correspondence and medical records in claim system notes and file documentation appropriately
• Close claim files when appropriate and retrieve closed files for re-filing as requested
• Provide ongoing support to claim staff on client service teams
• Communicate with medical providers, injured workers, and internal partners; frequent phone work is required
• Ensure compliance with corporate claim handling standards and special client handling instructions

Qualifications

• Associate Degree or two (2) years of related business experience
• Customer-service oriented mindset with comfort communicating by phone
• Strong organizational skills and ability to multitask effectively
• Ability to work efficiently on a computer and manage detailed documentation
• Proficiency with Microsoft Office applications including Word, Excel, and Outlook
• Nice to have: Knowledge of medical terminology, prior experience in claims, insurance, or medical administrative support, bilingual proficiency (Spanish)

Benefits

• 4 weeks (Paid time off that accrues throughout the year in accordance with company policy)
• + 10 paid holidays in your first year
• Comprehensive benefits: Medical, Dental, Vision, Life, and Disability Insurance
• Retirement plans: 401(k) and Employee Stock Ownership Plan (ESOP)
• Career growth: Internal training and advancement opportunities
• Culture: A supportive, team-based work environment