Med Claims Specialist

Med-Only Claims Specialist

Under the general supervision of the Worker's Compensation Claims Manager, this position is responsible for investigating, processing, and adjusting med-only worker's compensation claims.

The ability to make a difference to internal and external customers! Great variety in what you do each day in a fast-paced environment Flexibility with your schedule A supportive team environment Outstanding benefits that include : Company-paid retirement contribution into a SEP Plan (12.1% of salary, after one year of employment) Company-paid health insurance monthly premiums Tuition reimbursement for continuing education

Essential Duties & Responsibilities

• Sets up new medical-only files for handling.
• Investigaes and processes payments on medical-only claims in an accurate and timely manner; investigaes and processes payments.
• Reviews first report of injury forms (WC-12) and follows up with claimant, insured, medical providers, or others in a timely manner to determine compensability.
• Enters workers' compensation claims information into Origami (Claims System) in an accurate and timely manner.
• Interviews, telephones, or corresponds with member representatives, member employees, supervisors, claimants, witnesses, and medical personnel; reviews medical and hospital records in a timely manner to determine compensability while maintaining required confidentiality.
• Maintains and updates claim files with current diaries, file notes, and treatment plans in the claims system.
• Reviews and pays medical bills; Submits medical bills for third-party review.
• Researches and resolves medical bills billed to the claimant or sent to collection on the claimant's behalf.
• Processes and releases payments for Incentive Program to claimants.
• Monitors claims to identify and follow-up on subrogation opportunities.
• Refers chiropractic claims to a chiropractor for review.
• Handles or refers telephone, written, and e-mail inquiries from members and others.
• Composes and edits routine correspondence.

Other Duties & Responsibilities

Qualifications

High school diploma and the equivalent of one year of technical or business school training; and One to three (1 3) years related experience, or equivalent combination of education and experience.

Knowledge, Skills & Abilities To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and / or ability necessary.