Claims Examiner
Claims Examiner
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Salary Not Disclosed
1 Vacancy
Job Description
MedicalOnly Claims Examiner
Hybrid Spring Valley NY
6070k benefits
We are seeking a detailoriented and experienced MedicalOnly Claims Examiner to join our Workers Compensation team. The role involves managing claims that require medical treatment only (no lost time) ensuring compliance with state regulations and company policies. The ideal candidate will have a strong background in workers compensation claims particularly in NY and NJ.
Key Responsibilities:- Adjust medicalonly claims by completing 3point contact reviewing medical reports treatment plans and processing payments for medical expenses.
- Ensure compliance with workers compensation laws insurance policies and internal guidelines.
- Review medical records and treatment plans to assess eligibility for coverage and appropriate care.
- Communicate with healthcare providers to obtain necessary medical information and treatment updates.
- Process medical bills coordinate payments and maintain accurate claim files.
- Set and review claim reserves based on medical treatment and prognosis making necessary adjustments.
- Provide updates and resolve issues for injured workers employers and medical providers.
- Track claim status ensuring all medical documentation is received treatments are approved and claims are closed appropriately.
- Perform administrative tasks related to claim management including document filing and data entry.
- Education: High school diploma or equivalent (Associates or Bachelors degree preferred).
- Experience: 23 years of experience adjusting workers compensation claims in multiple jurisdictions. NY/NJ experience required; PA experience preferred.
- Prior experience in workers compensation medicalonly claims management preferred.
- Proficiency in Microsoft Office and ability to learn other claims management software.
- Strong written and verbal communication skills.
- High attention to detail and accuracy in claims processing.
- Excellent problemsolving and criticalthinking skills.
- Strong organizational and time management abilities.
- Selfmotivated with the ability to work independently.
- Due to the nature of the business participation in the oncall program may be required including availability on holidays and weekends as needed.
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Employment Type
Full Time
