Job Title : Claims Examiner
Hybrid)
Location : Spring Valley, NY 10977
Job Summary :
We are seeking a Medical-Only Claims Examiner to join our team in a hybrid work environment. The ideal candidate will have experience in workers' compensation claims management, particularly focusing on medical-only claims. The position requires proficiency in reviewing medical reports, treatment plans, and bills, as well as ensuring timely and accurate processing of medical expenses in compliance with applicable workers' compensation laws and insurance policies.
Top Reasons to Work with Us :
- Great work-life balance!
- Market leader in commercial insurance and risk management!
- Wide range of career paths and opportunities for growth!
- Competitive compensation and benefits including health insurance, retirement plans, and more!
What You Will Be Doing :
Adjust medical-only claims by completing 3-point contact, reviewing medical reports, treatment plans, and bills, ensuring timely processing and payment of medical expenses.Process claims in compliance with workers' compensation laws, company guidelines, and insurance policies.Review medical records and treatment plans to determine coverage eligibility and appropriate care.Communicate with healthcare providers to obtain necessary medical information, authorizations, and treatment updates.Process medical bills and coordinate with appropriate parties to ensure accurate and prompt payments, maintaining 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 and medical treatments are approved.Perform administrative duties related to claim management, including document filing and data entry into the claims management system .Experience and Qualifications :
Education : High School Diploma or equivalent required (Associate's or Bachelor's degree preferred).Experience :2-3 years adjusting workers' compensation claims in multiple jurisdictions (NY / NJ experience required; NY, NJ, PA experience preferred).
Previous experience in workers' compensation claims management, specifically medical-only claims, is preferred.Healthcare industry experience is preferred.Proficient in Microsoft Office and quick to learn new software applications.Excellent oral and written communication skills.Strong attention to detail with a high accuracy rate.Strong critical thinking, organizational, and time management skills.Ability to problem solve, use sound judgment, and work independently.
