Claims Representative - Workers Compensation

Mindlance

Phoenix, AZ

Apply

JOB DETAILS

SKILLS

Adjudication, Applications Security, Auditory, Best Practices, Claims Coding, Claims Processing, Compensation and Benefits, Computer Skills, Customer Relations, Develop and Maintain Customers, Documentation, Identify Issues, Industry Standards, Licensing, Medical Treatment, Medicare, Microsoft Office, Microsoft Product Family, Multitasking, Negotiation Skills, Presentation/Verbal Skills, Problem Solving Skills, Regulations, Subrogation, Team Player, Time Management, Utilization Management, Willing to Travel, Work From Home, Worker's Compensation, Writing Skills

LOCATION

Phoenix, AZ

POSTED

30+ days ago

Description:
Manager's note:
Office address: 10851 N. Black Canyon Highway Ste # 810 Phoenix, AZ 85029
Work location: See above Possibility of remote work for the right candidate.
Any specific skill/ certification/ license: Arizona WC jurisdiction proficiency / AZ lisc. or certification is a plus
Years of experience: 2 yrs or more of direct WC claim handling.

PRIMARY PURPOSE: To process low level workers compensation claims to determine benefits due; to ensure ongoing adjudication of claims within company standards and industry best practices; and to identify subrogation of claims and negotiate settlements with general supervision.

ESSENTIAL FUNCTIONS and RESPONSIBILITIES
Processes low level workers compensation claims determining compensability and benefits due on long term indemnity claims, monitors reserve accuracy, and files necessary documentation with state agency.
Develops and coordinates low level workers compensation claims' action plans to resolution, return-to-work efforts, and approves claim payments.
Approves and processes assigned claims, determines benefits due, and administers action plan pursuant to the claim or client contract.
Administers subrogation of claims and negotiates settlements.
Communicates claim action with claimant and client.
Ensures claim files are properly documented and claims coding is correct.
May process low-level lifetime medical and/or defined period medical claims which include state and physician filings and decisions on appropriate treatments recommended by utilization review.
Maintains professional client relationships.
ADDITIONAL FUNCTIONS and RESPONSIBILITIES
Performs other duties as assigned.
Supports the organization's quality program(s).
Travels as required.
QUALIFICATIONS

Education & Licensing
Bachelor's degree from an accredited college or university preferred.

Experience
Two (2) years of claims management experience or equivalent combination of education and experience or successful completion of Claims Representative training required.

Skills & Knowledge
Developing knowledge of regulations, offsets and deductions, disability duration, medical management practices and Social Security and Medicare application procedure as applicable to line of business
Excellent oral and written communication, including presentation 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 Service Expectations
WORK ENVIRONMENT
When applicable and appropriate, consideration will be given to reasonable accommodations.

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

NOTE: 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.

Requirements:
Manager's note:
Office address: 10851 N. Black Canyon Highway Ste # 810 Phoenix, AZ 85029
Work location: See above Possibility of remote work for the right candidate.
Any specific skill/ certification/ license: Arizona WC jurisdiction proficiency / AZ lisc. or certification is a plus
Years of experience: 2 yrs or more of direct WC claim handling.

EEO:

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

About the Company

Mindlance

Resume Resources

Free Resume Templates Free Resume Builder