Claims Analyst

Claims Analyst – Workers Compensation (Med Only)

· Determine coverage on new claims

· Contacting employer for initial investigation

· Contacting employee for information if needed (recorded statements, etc.)

· Reviewing medical bills to determine if payment is proper and referral of those bills for audit

· Filing necessary forms with the industrial commission

· Determining appropriate reserves for claims and entering them in the system

· Maintaining a diary of all medical only claims until closure

· Review and process all mail on a daily basis

· Complete tasks on diaried claims on a daily basis and ensure that follow-ups are completed on information requested but not received

· Close claims when medical bills are paid and file the necessary closure forms

· Calculate and complete paperwork for permanent partial disability benefits

· Review audited bills prior to payment

· Corresponding with attorneys on legal issues

· Determining when claims need medical case management services and arranging such

· Directing medical care of injured employees and arranging the care if needed

Qualifications:

To perform this job successfully, an individual must be able to satisfactorily complete each essential duty. 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, Skills and Abilities:

1. Language Skills: Fluent English is required. Spanish speaking is a plus. Ability to read, analyze and interpret medical records, legal decisions, general business communications, periodicals, professional journals and regulations. Ability to write, read and comprehend reports and business correspondence. Ability to effectively present (verbally and in writing) information and respond to questions form insureds and injured workers. Good oral and written communications skills.

2. Reasoning Ability: Ability to solve practical problems and to work independently, to carry-out assignments to completion with minimal supervision.

3. Good interpersonal skills

4. Ability to build and maintain relationships with insureds, injured workers and attorneys

5. Ability to develop and display resourcefulness.

Educational and Experience Requirements:

1. Bachelor Degree

2. 1 to 3 years of experience with Workers Compensation Claims Adjusting

Job Type: Full-time

Pay: From $45,000.00 per hour

Benefits:

• 401(k)
• Dental insurance
• Flexible schedule
• Flexible spending account
• Health insurance
• Life insurance
• Paid time off
• Professional development assistance
• Referral program
• Vision insurance

Schedule:

• Monday to Friday

COVID-19 considerations:
We are following current COVID protocols that are recommended.

Experience:

• Claims Adjusting: 1 year (Required)

Work Location: One location