Claims Associate - Medical only Examiner

Mindlance; Phoenix (AZ); Remote; USD 40,000 - 55,000; Full time

Job summary

A national staffing company is seeking a Claims Representative to analyze workers compensation claims and ensure proper adjudication. This remote position requires a high school diploma, strong communication skills, and the ability to handle multiple priorities. Candidates should have at least one year of office experience, preferably in claims. With a focus on quality and teamwork, this role plays a crucial part in managing employee benefits. Competitive, supportive work environment offered.

Qualifications

• One (1) year of general office experience or equivalent combination of education and experience required.
• Claims industry experience preferred.

Responsibilities

• Analyze reported lower-level workers compensation claims to determine benefits due.
• Supports other claims representatives with larger or complex claims.
• Processes claims determining compensability and benefits due.

Skills

Excellent oral and written communication skills

PC literacy including Microsoft Office

Analytical and interpretive skills

Strong organizational skills

Good interpersonal skills

Ability to work in a team environment

Education

High school diploma or GED

Job description

Overview

PRIMARY PURPOSE: To analyze reported lower-level workers compensation claims to determine benefits due; and to ensure ongoing adjudication of claims within company standards and industry best practices.

Responsibilities

• Adjusts medical-only claims and minor lost-time workers compensation claims under close supervision.
• Supports other claims representatives, examiners and leads with larger or more complex claims as necessary.
• Processes workers compensation claims determining compensability and benefits due; monitors reserve accuracy, and files necessary documentation with state agency.
• Communicates claim action/processing with claimant, client and appropriate medical contact.
• Ensures claim files are properly documented and claims coding is correct.
• May process routine payments and prescriptions and status reports for lifetime medical claims and/or defined period medical claims.
• Maintains professional client relationships.
• Performs other duties as assigned.
• Supports the organization\'s quality program(s).
• Performs other duties as assigned.

Additional Information

• Work environment and accommodations: When applicable and appropriate, consideration will be given to reasonable accommodations.

Qualifications

• Education & Licensing: High school diploma or GED required. Licenses as required.
• Experience: One (1) year of general office experience or equivalent combination of education and experience required. Claims industry experience preferred.
• Skills & Knowledge: Excellent oral and written communication skills; PC literate, including Microsoft Office products; analytical and interpretive skills; strong organizational skills; good interpersonal skills; ability to work in a team environment; ability to meet or exceed Performance Competencies.

Work & Physical Environment

Mental: Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines. Physical: Computer keyboarding; travel as required. Auditory/Visual: Hearing, vision and talking.

Credit security clearance, confirmed via a background credit check, is required for this position.

The statements contained in this document are intended to describe the general nature and level of work being performed by a colleague assigned to this description. They are not intended to constitute a comprehensive list of functions, duties, or local variances. Management retains the discretion to add or to change the duties of the position at any time.

Work location: Remote within Arizona

EEO: “Mindlance is an Equal Opportunity Employer and does not discriminate in employment on the basis of – Minority/Gender/Disability/Religion/LGBTQI/Age/Veterans.”