Medical-Only Claims Examiner ESF6568
Medical-Only Claims Examiner ESF6568
Posted on :
05-04-2025
Employer Active
1 Vacancy
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Yearly Salary
$ 60000 - 70000
Vacancy
1 Vacancy
Posted on :
05-04-2025
Job Description
- Great worklife balance!
- Market leader in commercial insurance and risk management!
- Offer a wide range of career paths and opportunities for growth!
- Competitive Compensation and Benefits: health insurance retirement plans and other benefits!
What you will be doing:
- Adjust medicalonly claims by completing 3point contact reviewing medical reports treatment plans and bills and ensuring timely processing and payment of medical expenses.
- Ensure claims are processed in compliance with applicable workers compensation laws company guidelines and insurance policies.
- Review medical records and treatment plans to determine eligibility for coverage and appropriate care.
- Communicate with healthcare providers to obtain necessary medical information authorizations and treatment updates.
- Process medical bills coordinate with the appropriate parties to ensure payments are issued accurately and promptly and maintain accurate claim files.
- Set and review claim reserves based on medical treatment and case prognosis adjusting reserves as necessary.
- Communicate with injured workers employers and medical providers to address questions provide updates and resolve issues related to medical treatment and benefits.
- Track the status of claims ensuring that necessary medical documentation is received medical treatments are approved and claims are closed appropriately when resolved.
- Perform other administrative duties related to claim management as needed including document filing and data entry into the claims management system.
Experience you will need:
- High School Diploma or equivalent (Associates or Bachelors degree preferred).
- Previous experience in workers compensation claims management specifically medicalonly claims is preferred.
- Proficient in Microsoft Office and has an aptitude to learn other software applications.
- Excellent oral and written communication skills.
- Detail oriented with a high accuracy rate.
- Strong critical thinking and organizational skills.
- Ability to problem solve and use good judgment.
- Selfmotivated with excellent time management skills.
- 23 years adjusting worker’s compensation claims in multiple jurisdictions.
- NY NJ PA experience preferred. NY/NJ experience required.
- Healthcare industry experience preferred.
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Employment Type
Full Time
Key Skills
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