Claims Examiner, Medical Only

Responsibilities

• Investigates losses of low to moderate severity to determine cause, scope and extent of injury and/or liability for potential subrogation
• Verifies coverage and confirms policy conditions have been met
• Obtains missing information and ensures data integrity for regulatory reporting
• Communicates effectively with claimants, policyholders, underwriters, agents, and other internal and external stakeholders
• Authorizes medical treatment and schedules medical appointments
• Establishes medical reserves, approves medical bills and reviews/requests medical records
• Documents all correspondence, reports, discussions, and decisions in claim file notes

Qualifications

• Proficiency with MS Word, Excel, and other business applications
• Demonstrated skills in critical thinking and independent decision making
• State licensing requirements (if applicable)

Preferred

• Minimum of 2 years handling Medical Only or other Workers’ Compensation claims experience
• Basic knowledge of medical conditions, treatment plans and casual relation to occupational injury/illness
• Drive and desire to use this position as a starting point to potentially enter the Claim Associate training program and become a lost time adjuster in the future

What We Offer

• Medical & Dental Plans
• Life Insurance, including eligible spouses & children
• Health Care Flexible Spending
• Dependent Care
• 401k Savings Plans
• Paid Time Off