Medical-Only Claims Examiner

Position Overview

Now Hiring!: Medical-Only Claims Examiner Location: Spring Valley, NY 10977 Compensation: $60,000 - $75,000 What's in it for You:

• Medical, Dental, Vision Benefits
• Competitive Compensation
• 401K eligible upon 1st day of employment
• FSA & DCA Accounts
• Career advancement opportunities in an expanding company

 

 

Job Summary: Highview National Insurance is an insurance carrier that provides workers’ compensation coverage. We pride ourselves on having an exceptional team environment, with multiple avenues for growth opportunities. 

We are seeking a detail-oriented and experienced NY/NJ Medical-Only Claims Examiner to join our Workers' Compensation team.  As Medical-Only Claims Examiner, you will be responsible for managing claims that involve medical treatment only (no lost time), ensuring that claims are handled efficiently, accurately, and in accordance with company policies and state regulations.

 

 

 

Essential Job Functions:

• 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, maintain accurate claim files, coordinate with the appropriate parties to ensure payments are issued accurately and promptly.
• 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. P
• Perform other administrative duties related to claim management as needed, including document filing and data entry into the claims management system.
• Performs other duties as assigned.

 

 

Required Skills/Abilities:

• 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.
• Onsite presence at our office in Spring Valley, NY at least two (2) days per week.

 

 

Education and Experience:

• Minimum of three (3) years of experience adjusting worker's compensation claims in multiple jurisdictions.
• NY and NJ experience required; NY, NJ, and PA preferred.
• Healthcare industry experience preferred.

 

 

 

Who We Are: Highview National Insurance highviewins.comHighview National is an insurance company with decades of experience in commercial insurance and risk management. We‘re focused on making the process of procuring insurance as simple and as smooth as possible.

 

This list of functions, duties, responsibilities, and skills is not intended to be all-inclusive, and the employer reserves the right to assign additional duties and responsibilities as necessary.

 

Highview National Insurance is an Equal Opportunity Employer. Highview National Insurance does not discriminate based on race, religion, color, sex, gender identity, sexual orientation, age, non-disqualifying physical or mental disability, national origin, veteran status, or any other basis covered by appropriate law. All employment is decided based on qualifications, merit, and business need.

 

Pay Range

USD $60,000.00 - USD $70,000.00 /Yr.

Salary : $60,000 - $70,000