Med-Only Claims Specialist

Join to apply for the Med-Only Claims Specialist role at Cities and Villages Mutual Insurance Company

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.

WHY JOIN THE CVMIC TEAM :

• 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
• View what employees say about working here!
• Sets up new medical-only files for handling.
• Investigates and processes payments on medical-only claims in an accurate and timely manner; investigates 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

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 required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Knowledge of :

Ability to :

Seniority level

Employment type

Job function

Industries

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