Medical Claims Specialist (entry level)

About the role

This is an excellent opportunity to be trained into the world of workers’ compensation claims adjusting. The Medical Claims Specialist is a junior role supporting Workers Compensation Claims Adjusters by handling light to moderate claims, allowing indemnity adjusters 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 company's success while positively impacting lives. We seek candidates with strong negotiation and persuasion skills, a high aptitude to learn and apply medical and legal principles, and the ability to thrive in a challenging and fast-paced environment.

Responsibilities

• Determine coverage and compensability for reported claims
• Accurately set reserves, ensuring timely updates 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, and 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 convey complicated information clearly to a broad audience of varying backgrounds
• Working knowledge of Microsoft Word and Excel, with aptitude to learn other software programs

Qualifications

• A keen, logical mind and strong aptitude for analytical thinking
• Rock-solid honesty, openness, and ethical values
• Highly collaborative, ego-free work style; ability to fit into a culture where people genuinely enjoy working together
• Bachelor’s degree is a plus but not required

Benefits

• Competitive pay
• Paid parental bonding leave
• Tuition reimbursement
• 401K
• Paid vacation and sick leave

Omaha National provides a stable, positive work environment and excellent benefits.