What are the responsibilities and job description for the Claims Examiner - Medical only - Workers comp position at Mai Placement?
Medical-Only Claims Examiner
Hybrid – Spring Valley NY
60-70k benefits
Job Summary:
We are seeking a detail-oriented and experienced Medical-Only 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 medical-only claims by completing 3-point 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.
Required Skills & Qualifications:
- Education: High school diploma or equivalent (Associate's or Bachelor's degree preferred).
- Experience: 2-3 years of experience adjusting workers' compensation claims in multiple jurisdictions. NY/NJ experience required; PA experience preferred.
- Prior experience in workers' compensation medical-only 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 problem-solving and critical-thinking skills.
- Strong organizational and time management abilities.
- Self-motivated with the ability to work independently.
Additional Requirements:
- Due to the nature of the business, participation in the on-call program may be required, including availability on holidays and weekends as needed.
Email: Baila@maiplacement.com
Job Type: Full-time
Pay: $60,000.00 - $70,000.00 per year
Schedule:
- Holidays
- On call
- Weekends as needed
Work Location: Hybrid remote in Spring Valley, NY 10977
Salary : $60,000 - $70,000
