Medical Only Claims Trainee

ESSENTIAL DUTIES AND RESPONSIBILITIES

• Assist Medical Only Claims Specialist with the investigation and management of workers compensation claims.
• Affords support to the on-going medical treatment program including directing care, creating panels, and approving provider requests.
• Evaluates medical reports and correspondence for appropriate action/documentation.
• Serves as a point of contact for the multi-functional claims team, ensuring the appropriate and timely handling of claims in other states.
• May act as a backup to the Medical Only Claims Specialist I, verifying workers' compensation coverage of employers and injured employees.
• Documents specifics of claims with potential for subrogation, approves payment based on knowledge of the treatment plan, and concludes and closes files following resolution of claims.
• Coordinates with outside vendors to ensure cost containment efforts.
• Establishes and maintains effective working relationships with all internal and external customers.
• Supports the customer service work and processes for the multi-functional claims team.
• Communicates and collaborates with team members to ensure the appropriate and timely handling of claims in other states.
• Demonstrates growth of skills working towards the more complex responsibilities of the Medical Only Claims Specialist I position.
• Increase knowledge of how Accident Fund Insurance Company of America runs and how Workers Compensation Insurance works.

Qualifications

• Relevant combination of education and experience may be considered in lieu of degree.
• High school diploma or equivalent.
• 2 years insurance experience (could add finance, medical, or any other applicable experience).
• Associates degree in insurance, business administration, health administration and/or related field.
• Progress towards or completion of Insurance Institute of America (IIA) or other insurance related designation(s) preferred.