Med-Only Claims Specialist

Under the general supervision of the Workers Compensation Claims Manager this position is responsible for investigating processing and adjusting med-only workers 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!

Essential Duties & Responsibilities

• 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 claimants 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

• Attends Restitution Hearings.

• Learning and maintaining knowledge of the Medicare (CMS) process and identifying claims that are eligible.

• Assists the Administrative Assistant as needed.

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

Knowledge of:

• Wisconsin Workers Compensation Act administrative code and case law.

• Claims handling practices and procedures.

• Office machines and proficiency in the use of computers and computer software including Microsoft Word Outlook Excel claims software (Origami) and other business software.

• Medicare.

Ability to:

• Handle sensitive situations in a professional manner that reflects favorably upon the member and the Company.

• Effectively manage multiple assignments or tasks.

• Effectively work as a member of a team coordinating and completing assignments in a timely manner.

• Communicate professionally timely and effectively both orally and in writing.

• Read and accurately interpret documents such as medical records and legal documents.

• Accurately and efficiently write routine reports and correspondence.

• Effectively and professionally present information and respond to questions from clients claimants medical service providers and member representatives.

We Make it Easy

Founded in 1901 MRA is a nonprofit employer association that serves more than 4000 employers covering more than one million employees.

As one of the largest employer associations in the nation MRA helps its member organizations thrive by offering the most comprehensive assortment of HR services information education and resources to help build successful workplaces and a powerful workforce.

We partner with these companies working directly with their HR department and leadership to hire their talent. We are a direct line to the company not an agency recruiter.