Workers Compensation Claims Specialist - Remote

Aveanna Healthcare; Atlanta (GA); Remote; USD 40,000 - 75,000; Full time

Job summary

An established industry player seeks a Workers Compensation Claims Specialist to serve as a vital link between field staff and third-party administrators. This remote role involves investigating and resolving claims efficiently while ensuring excellent customer service. The ideal candidate will have substantial experience in claims handling, particularly in workers' compensation, and possess strong problem-solving abilities. Join a dynamic team where your contributions will directly impact the claims process and enhance service delivery. If you thrive in a fast-paced environment and have a keen eye for detail, this opportunity is perfect for you.

Qualifications

• 5+ years experience in Claims and Litigation or 4 years with a Bachelor’s Degree.
• Knowledge of claims handling and legal statutes is essential.

Responsibilities

• Investigating and administering workers' compensation claims.
• Reviewing medical reports and approving claims.
• Representing the company at claims actions and hearings.

Skills

Claims Handling

Customer Service

Attention to Detail

Effective Problem-Solving

Time Management

Education

High School Diploma

Bachelor’s Degree

Job description

This is a remote position.

Position Overview
The Workers Compensation Claims Specialist is responsible for the being the liaison between the Aveanna Field Staff and the third party administrator. This role will require investigation of claims and insurance that our third party administrator is managing the claims in an effect manner. This position will resolve claims according to Best Practices and within authority limits by following established protocols to ensure that claims are handled in the most efficient, effective way while delivering excellent customer claims service.

Essential Job Functions
Investigating, reviewing, evaluating, and administering workers' compensation claims
Reviewing medical reports
Setting reserves
Filing documentation
Reviewing and approving medical bills for payment
Reviewing accident and injury reports
Interviewing and correspond with claimants, witnesses, attorneys, and physicians
Approving claims or recommending denial
Representing Aveanna at various workers' compensation and industrial leave claims actions and hearings
Perform other duties as assigned

Requirements
High School Diploma and 5 years or more experience in Claims and Litigation OR a Bachelor’s Degree and 4 years’ experience in Claims and Litigation
Knowledge of claims handling and legal statutes and procedures
Customer service experience
Workers Comp experience in California, Texas, and Pennsylvania and non-subscriber claim experience highly preferred

Other Skills/Abilities
Attention to detail
Time Management
Effective problem-solving and conflict resolution
Good organization and communication skills

Physical Requirements
Must be able to speak, write, read and understand English
Occasional lifting, carrying, pushing and pulling of 25 pounds
Prolonged sitting, walking, standing, bending, kneeling, reaching, twisting
Must be able to sit and climb stairs
Must have visual and hearing acuity
Must have strong sense of smell and touch

Environment
Performs duties in an office environment during agency operating hours
Must be able to function in a wide variety of environments which may involve exposure to allergens and other various conditions

Other Duties
Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice.

Vaccination Requirement
As an employer accepting Medicare and Medicaid funds, employees must comply with all health-related requirements in all relevant jurisdictions, including required vaccinations and testing, subject to exemptions for medical or religious reasons as appropriate.

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