Medical Only Workers Compensation Claims Examiner

Agupdate; Atlanta (GA); Remote; USD 40,000 - 55,000; Full time

Job summary

A leading company seeks a candidate for a remote position focusing on the verification of workers' compensation claims. The role involves ensuring claims progress towards closure, customer service, and managing inquiries. A high school diploma and foundational experience in claims administration are required.

Qualifications

• Foundational experience (typically 2 years) in workers' compensation claim administration.
• Equivalent combination of education and experience.

Responsibilities

• Verifies the compensability of workers' compensation claims.
• Checks claims diary and ensures claims closure.
• Provides customer support and responds to inquiries.

Skills

Outstanding customer service

Teamwork

Organizational commitment

Education

High school diploma or equivalent

Job description

Note: This employer is open to candidates who want to work remote.

Interested parties may submit their resume via: https://accg.isolvedhire.com/jobs/.

Candidate selected to fill this position must live within the state of Georgia. The employee's telecommuting work site must contain a designated and approved workspace at the employee's home address.

Employee is required to have and maintain a high-speed, broadband internet connection at their work site that is sufficient to enable fast, consistent service to the membership. A minimum download speed of 25 Mbps is required. A 40 Mbps internet connection is recommended. You may check your download speed at www.speedtest.net.

General Definition of Work:

Performs moderately difficult technical work verifying the compensability of workers' compensation claims, preparing and processing claims and related correspondence, contacting employers and medical providers, responding to inquiries, and related tasks as assigned. Work is performed under limited supervision of the Insurance Services Supervisor.

Position Responsibilities

• Supports the Association's "Four Pillars"—civic engagement, leadership development, legislative advocacy, and membership services—through support of division or program staff and interaction with local governments and authorities. Has knowledge of and understanding of the programs and services offered by the Association, providing outstanding customer support that reflects well on the organization.
• Provides and exhibits outstanding customer service, teamwork, and organizational commitment.
• Checks worker's compensation claims diary periodically to identify newly assigned claims, ensuring claims move toward closure within established time frames.
• Verifies the compensability of workers' compensation claims, contacts employers and medical providers to verify facts and obtain additional information as needed, and follows up on work and treatment status. Identifies and pursues subrogation recoveries.
• Receives and responds to inquiries via telephone and email, providing information or forwarding callers to appropriate parties.
• Performs proper and timely reserve evaluations and adjustments; reviews and approves bills for processing; reviews and signs off on the daily check report.
• Completes Electronic Data Interchange (EDI) transmissions, state board filings, and meets Centers for Medicare & Medicaid Services (CMS) requirements.
• Supports the organization by executing directives from the Association.

Education and Experience

• High school diploma or equivalent.
• Foundational experience (typically 2 years) in workers' compensation claim administration, or
• Equivalent combination of education and experience.