What are the responsibilities and job description for the Medical-Only Claims Examiner (Hybrid) position at ExpertHiring?
Job Description
Top Reasons to Work with our client
Great work-life 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!
Job Type : Full Time Location : Spring Valley, New York Pay : Competitive Pay & Benefits! Job Description What you will be doing :
Adjust medical-only claims by completing 3-point 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 (Associate's or Bachelor's degree preferred).
Previous experience in workers' compensation claims management, specifically medical-only 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.
Self-motivated with excellent time management skills.
2-3 years adjusting worker's compensation claims in multiple jurisdictions.
NY, NJ, PA experience preferred. NY / NJ experience required.
Healthcare industry experience preferred.
Our client asked me to submit 3 great people within the next few days. We work directly with the hiring manager and can arrange interviews within a few days
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