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Medical Claims Specialist

Omaha National
  • Omaha, Nebraska
    13 days ago

    Job Description

    This is an excellent opportunity to be trained into the world of workers’ compensation claims adjusting.  The Medical Claims Specialist is a junior role to the Workers Compensation Claims Adjusters. In this role you will handle light to moderate claims. Your role will allow indemnity adjusters time to focus on more in-depth and complex cases. Workers compensation adjusting is an intellectually interesting and professionally rewarding position that plays a critical role in the success of the company while positively impacting lives. Your strong negotiation and persuasion skills; high aptitude to learn and effectively apply medical and legal principles; and ability to thrive in a challenging and fast paced role are attributes we want on our team.
     
    RESPONSIBILITIES:
    • Determine coverage and compensability for reported claims
    • Accurately set reserves, ensuring that timely updates are made with claim developments
    • Maintain compliance with regulatory deadlines, benefit calculations, state reporting, and benefit notices
    • Achieve favorable settlements through timely identification of settlement opportunities; accurate settlement valuations; and effective negotiation practices
    • Direct vendors such as field nurses, investigators, defense attorneys to positively impact claims outcomes
     
    REQUIREMENTS:
    • Ability to comprehend and learn new workers’ compensation regulations while interpreting complex legal and medical documents.
    • Strong verbal and written communication skills with the ability to effectively communicate with a broad audience of varying backgrounds, frequently conveying complicated information in a way easily understood by a layperson
    • Working knowledge of Microsoft Word, Excel, with aptitude to learn other software programs
     
    QUALIFICATIONS:
    • A keen, logical mind and a strong aptitude for analytical thinking
    • Strong oral and written communication skills 
    • Rock-solid honesty, openness, and ethical values
    • Highly collaborative, ego-free work style; fit into a culture in which people genuinely enjoy working together
    • Working knowledge of Microsoft Word and Excel and the ability to rapidly master specialized software programs 
    • Bachelor’s degree is a plus but not required
     
    BENEFITS:
    Omaha National provides a stable, positive work environment, competitive pay, excellent benefits, such as paid parental bonding leave, tuition reimbursement, 401K, and paid vacation and sick leave.
     

    Numbers & Facts

    LocationOmaha, Nebraska
    Websitehttps://www.omahanational.com/careers/

    Skills

    • Analysis Skillsunmatched
    • Claims Processingunmatched
    • Communication Skillsunmatched
    • Interpret Regulationsunmatched
    • Legalunmatched
    • Legal Documentsunmatched
    • Maintain Complianceunmatched
    • Medical Protocolsunmatched
    • Microsoft Excelunmatched
    • Microsoft Wordunmatched
    • Negotiation Skillsunmatched
    • Nursingunmatched
    • Persuasion Skillsunmatched
    • Presentation/Verbal Skillsunmatched
    • Regulatory Complianceunmatched
    • Team Playerunmatched
    • Time Managementunmatched
    • Worker's Compensationunmatched
    • Writing Skillsunmatched

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