Medical Only Claims Specialist

Role Overview

• Manages non-complex and non-problematic, medical only claims and minor lost-time workers’ compensation claims under close supervision
• Receives claims, confirms policy coverage and acknowledgment of the claim
• Determines the validity and compensability of the claim
• Establishes reserves and authorizes payments within established reserving authority limits
• Communicates claim status with the customer, claimant and client
• Adheres to client and carrier guidelines and participates in claims review as needed
• Assists other claims professionals with more complex or problematic claims as necessary
• Additional duties as assigned

Requirements

• Bachelor's degree or a combination of education and related experience
• Minimum of 1 year industry experience and claim handling WC experience required
• Licensed as required jurisdictionally

Benefits

• Medical (HDHP) w/Pharmacy
• Dental
• Vision
• Long Term Disability
• Health Savings Account
• Flexible Spending Account Options
• Life Insurance
• Accident Insurance
• Critical Illness Insurance
• Pre-paid Legal Insurance
• Parking and Transit FSA accounts
• 401K
• ROTH 401K
• Paid time off