Claims Associate

Claims Analyst

Years of experience : 2 years or more of direct claim handling or applicable transferable skills in the claims industry. Work location : Remote within Arizona

Primary Purpose : To analyze reported lower-level workers compensation claims to determine benefits due; and to ensure ongoing adjudication of claims within company standards and industry best practices.

Essential Functions and Responsibilities :

Adjusts medical-only claims and minor lost-time workers compensation claims under close supervision. Supports other claims representatives, examiners, and leads with larger or more complex claims as necessary. Processes workers compensation claims determining compensability and benefits due; monitors reserve accuracy, and files necessary documentation with state agency. Communicates claim action / processing with claimant, client, and appropriate medical contact. Ensures claim files are properly documented and claims coding is correct. May process routine payments and prescriptions and status reports for lifetime medical claims and / or defined period medical claims. Maintains professional client relationships. Performs other duties as assigned. Supports the organization's quality program.

Qualification :

Education & Licensing : High school diploma or GED required. Licenses as required.

Experience : One (1) year of general office experience or equivalent combination of education and experience required. Claims industry experience preferred.

Skills & Knowledge : Excellent oral and written communication skills. PC literate, including Microsoft Office products. Analytical and interpretive skills. Strong organizational skills. Good interpersonal skills. Ability to work in a team environment. Ability to meet or exceed Performance Competencies.

Work Environment :

When applicable and appropriate, consideration will be given to reasonable accommodations. Mental : Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines. Physical : Computer keyboarding, travel as required. Auditory / Visual : Hearing, vision and talking.

Note : Credit security clearance, confirmed via a background credit check, is required for this position.

Nesco Resource offers a comprehensive benefits package for our associates, which includes a MEC (Minimum Essential Coverage) plan that encompasses Medical, Vision, Dental, 401K, and EAP (Employee Assistance Program) services. Nesco Resource provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state, or local laws.