Remote Medical Claims Specialist – Workers' Comp

Old Republic Commercial Risk; Walnut Creek (CA); On-site; USD 58,000 - 73,000; Full time

Job summary

Old Republic Commercial Risk in Walnut Creek, CA, seeks a claims professional to manage medical-only and limited lost time claims, aiming to minimize losses and deliver superior customer service.

You will contact accounts on first notices of loss, process payments, authorize treatments, maintain follow-up diaries, and ensure regulatory compliance while coordinating with the network of physicians and vendors.

Strong organizational skills and proficiency with MS Excel and Word are essential.

Qualifications

• High school diploma or equivalent.
• At least 1 year of Workers' Compensation claims handling experience.
• License required or obtainable within 90 days in mandated states.
• Familiarity with medical terminology.

Responsibilities

• Contact accounts on First Notices of Loss to obtain missing file information.
• Process payments, answer calls, and authorize medical treatment for Medical Only claims.
• Maintain diaries for follow-up and ensure timely 24-hour contacts.
• Determine treatment appropriateness and causally relate to injury.
• Redirect treatment to network physicians as appropriate
• Refer subrogation or permanency concerns to supervisor.
• Work to ensure compliance with jurisdictional requirements for Medical Only claims.

Skills

Claims handling

Medical terminology

Attention to detail

Organizational skills

Verbal communication

Written communication

Independent work

Remote work

Education

High school diploma

Tools

MS Excel

MS Word

Job description

Old Republic Commercial Risk in Walnut Creek, CA, seeks a claims professional to manage medical-only and limited lost time claims, aiming to minimize losses and deliver superior customer service.

You will contact accounts on first notices of loss, process payments, authorize treatments, maintain follow-up diaries, and ensure regulatory compliance while coordinating with the network of physicians and vendors.

Strong organizational skills and proficiency with MS Excel and Word are essential.