Associate Claims Specialist - Medical Only

externalpmacompanies; Tampa (FL); On-site; USD 55,000 - 75,000; Full time

Job summary

externalpmacompanies Tampa, FL is seeking a Claims Professional to proactively manage medical only and limited lost time claims and supervise permanent total claims to minimize losses. You will provide superior customer service and coordinate with medical providers.

Responsibilities include interfacing with First Notices of Loss for file setup, processing payments, and ensuring timely diary follow-ups, while maintaining compliance with jurisdictional requirements and licensing.

Qualifications

• High school diploma or equivalent.
• One or more years of Workers Compensation claims handling experience.
• License required or ability to obtain license within 90 days of employment in mandated states - FL, GA, AL.
• Familiarity with medical terminology.
• Ability to work independently, handle multiple tasks simultaneously, make difficult decisions and focus on details.
• Strong organizational skills.
• Excellent verbal and written communication skills.
• Proficiency MS Excel and MS Word.

Responsibilities

• Contact accounts on First Notices of Loss to obtain missing information pertinent to file set-up.
• Process payments, answer phone calls, authorize treatment associated with Medical Only claims.
• Complete appropriate contacts within 24 hours of assignment, and establish and maintain appropriate diary for follow-up.
• Determine whether treatment is appropriate and causally related to the compensable injury.
• Redirect treatment to network physicians as appropriate.
• Refer subrogation potential claims or potential permanency claims to Supervisor.
• Work to ensure compliance with all appropriate jurisdictional requirements on Medical Only claims, including timely form filing if applicable.
• Maintain a working knowledge of jurisdictional requirements and obtain/maintain state adjusting licenses.
• Administer benefits on Permanent Total or Death cases, which includes monitoring for changes in life or work status, implied interest in resolution or marked increases in costs.
• Demonstrate commitment to Company’s Code of Business Conduct and Ethics, and apply knowledge of compliance policies and procedures, standards and laws applicable to job responsibilities in the performance of work.

Skills

Attention to detail

Organizational skills

Verbal communication

Written communication

Education

High school diploma

Tools

MS Excel

MS Word

Job description

As a member of our Claims team, you will proactively manage medical only and limited lost time claims in order to minimize losses, manage permanent total claims in order to minimize losses, and provide superior customer service.

Responsibilities:

• Contact accounts on First Notices of Loss to obtain missing information pertinent to file set-up
• Process payments, answer phone calls, authorize treatment associated with Medical Only claims
• Complete appropriate contacts within 24 hours of assignment, and establish and maintain appropriate diary for follow-up
• Determine whether treatment is appropriate and causally related to the compensable injury
• Redirect treatment to network physicians as appropriate
• Refer subrogation potential claims or potential permanency claims to Supervisor
• Work to ensure compliance with all appropriate jurisdictional requirements on Medical Only claims, including timely form filing if applicable
• Maintain a working knowledge of jurisdictional requirements and obtain/maintain state adjusting licenses
• Administer benefits on Permanent Total or Death cases, which includes monitoring for changes in life or work status, implied interest in resolution or marked increases in costs.
• Demonstrate commitment to Company’s Code of Business Conduct and Ethics, and apply knowledge of compliance policies and procedures, standards and laws applicable to job responsibilities in the performance of work.

• High school diploma or equivalent
• One or more years of Workers Compensation claims handling experience
• License required or ability to obtain license within 90 days of employment in mandated states - FL, GA, AL
• Familiarity with medical terminology
• Ability to work independently, handle multiple tasks simultaneously, make difficult decisions and focus on details
• Strong organizational skills
• Excellent verbal and written communication skills
• Proficiency MS Excel and MS Word.