Claims Specialist

Insight Global; Reading (Berks County); On-site; USD 28,000 - 47,000; Full time

Benefits offered by this job

Medical, Dental, Vision Insurance

HSA, FSA, DCFSA options

401k with employer matching

Paid time off

Job summary

Insight Global is seeking a Medical Only and Subrogation Oversight Claims Examiner to manage Medical Only workers' compensation claims and oversee liens and subrogation matters. This role collaborates with Claims Examiners and stakeholders to ensure timely resolution and protect financial interests.

The ideal candidate has 2–3 years of workers' compensation claims experience, knowledge of subrogation and contract language, and proficiency with claims software and MS Office.

Qualifications

• Requires 2–3 years experience in workers' compensation claims management or related field.
• Experience handling Medical Only workers' compensation claims.
• Familiarity with subrogation, lien management, indemnification terms, and TPAs or self-insureds is a plus.

Responsibilities

• Manage Medical Only workers' compensation claims from intake to closure.
• Monitor liens and subrogation opportunities.
• Collaborate with examiners to ensure compliant claim handling.
• Review contract language to determine liability and recovery opportunities.
• Communicate with medical providers, counsel, claimants, and stakeholders.
• Maintain accurate claim files and prepare status reports.

Skills

Workers' compensation knowledge

Analytical thinking

Communication skills

Time management

Contract language interpretation

Education

Bachelor's degree in related field

Associate's degree option with relevant experience

Paralegal certificate or contract law coursework

Workers' Compensation certification (AIC etc) preferred

Tools

Microsoft Office Suite

Claims management software

Job description

Medical Only and Subrogation Oversight Claims Examiner

Position Summary

The Medical Only and Subrogation Oversight Claims Examiner is responsible for the management of Medical Only workers' compensation claims and the oversight of workers' compensation liens and subrogation matters. This position works collaboratively with Workers' Compensation Claims Examiners and various stakeholders to ensure timely and accurate claim resolution while protecting the organization's financial interests.

Education Requirements

• Bachelor's degree in Business Administration, Risk Management, Healthcare Administration, Paralegal Studies, or a related field
• An Associate's degree with additional relevant experience may be considered in lieu of a Bachelor's degree
• Paralegal certificate or coursework in contract law is a plus
• Workers' Compensation certification (e.g., Associate in Claims - AIC) preferred

Work Experience Requirements

• Minimum 2–3 years of experience in workers' compensation claims management, insurance, or a related field
• Experience handling Medical Only workers' compensation claims
• Knowledge of subrogation principles and lien management within workers' compensation
• Familiarity with contract language, including indemnification clauses and liability agreements
• Experience working with third-party administrators (TPAs) or self-insured employers is a plus
• Prior experience in risk management or insurance departments preferred
• Demonstrated ability to manage multiple cases and deadlines simultaneously
• Experience communicating with medical providers, legal counsel, and claimants
• Proficiency in claims management software and Microsoft Office Suite

Key Responsibilities

• Manage and oversee Medical Only workers' compensation claims from inception to closure
• Monitor and track workers' compensation liens and subrogation opportunities
• Collaborate with Workers' Compensation Claims Examiners to ensure consistent and compliant claim handling
• Review and interpret contract language, including indemnification clauses, to determine liability and recovery opportunities
• Communicate effectively with medical providers, legal counsel, claimants, supervisors, and other stakeholders
• Establish and adhere to deadlines for claim resolution and subrogation recovery
• Identify and pursue subrogation opportunities to maximize cost recovery
• Maintain accurate and up-to-date claim files and documentation
• Prepare reports and provide updates on claim status, lien activity, and subrogation recoveries
• Ensure compliance with applicable state and federal workers' compensation laws and regulations
• Assist in the development and implementation of policies and procedures related to Medical Only claims and subrogation
• Participate in claim reviews and meetings as required

Technical Skills

• Strong knowledge of workers' compensation laws, regulations, and best practices
• Proficiency in reading and interpreting contract language and legal documents
• Understanding of medical terminology and treatment protocols
• Familiarity with subrogation laws and lien resolution processes
• Proficiency in claims management software and Microsoft Office Suite

Organizational Skills

• Exceptional ability to prioritize and manage multiple tasks simultaneously
• Strong attention to detail and accuracy
• Ability to create, manage, and adhere to deadlines
• Effective case management and file organization skills

Communication Skills

• Excellent written and verbal communication skills
• Ability to communicate effectively with diverse individuals including medical providers, legal counsel, claimants, and senior management
• Strong negotiation and conflict resolution skills
• Ability to present complex information in a clear and concise manner

Analytical & Decision-Making Skills

• Strong analytical and problem-solving abilities
• Ability to evaluate complex claims and make sound, timely decisions
• Capacity to assess liability and identify cost recovery opportunities
• Ability to exercise sound judgment and work independently

Interpersonal Skills

• Collaborative team player with the ability to work independently
• Professional demeanor and strong work ethic
• Self-motivated with the drive to move matters forward to resolution
• Adaptable and able to thrive in a fast-paced environment

Preferred Qualifications

• Workers' Compensation certification (e.g., Associate in Claims - AIC or Associate in Risk Management - ARM)
• Experience with public entity or municipal workers' compensation programs
• Bilingual communication skills are a plus
• Experience with self-insured workers’ compensation programs

Physical Requirements

• Ability to sit for extended periods and work at a computer workstation
• Occasional travel may be required for claim investigations or meetings
• Ability to lift and carry files and documents up to 20 pounds

Compensation

$20-34/hr

Exact compensation may vary based on several factors, including skills, experience, and education.

Benefit packages for this role will start on the 31st day of employment and include medical, dental, and vision insurance, as well as HSA, FSA, and DCFSA account options, and 401k retirement account access with employer matching. Employees in this role are also entitled to paid sick leave and/or other paid time off as provided by applicable law.