Claims Associate - Medical only Examiner

Description : Manager's note :

Any specific skill / certification / license : Prior medical only desk level handling is a plus / AZ lisc. or certification is a plus

Years of experience : yrs or more of direct claim handling or applicable transferable skills in the claims industry.

Work location : Remote within Arizona

PRIMARY PURPOSE : To analyze reported lower-level workers compensation claims to determine benefits due; and to ensure ongoing adjudication of claims within company standards and industry best practices.

ESSENTIAL FUNCTIONS and RESPONSIBILITIES

Adjusts medical-only claims and minor lost-time workers compensation claims under close supervision.

Supports other claims representatives, examiners and leads with larger or more complex claims as necessary.

Processes workers compensation claims determining compensability and benefits due; monitors reserve accuracy, and files necessary documentation with state agency.

Communicates claim action / processing with claimant, client and appropriate medical contact.

Ensures claim files are properly documented and claims coding is correct.

May process routine payments and prescriptions and status reports for lifetime medical claims and / or defined period medical claims.

Maintains professional client relationships.

ADDITIONAL FUNCTIONS and RESPONSIBILITIES

Performs other duties as assigned.

Supports the organization's quality program(s).

QUALIFICATION

Education & LicensingHigh school diploma or GED required. Licenses as required.

ExperienceOne () year of general office experience or equivalent combination of education and experience required. Claims industry experience preferred.

Skills & Knowledge

Excellent oral and written communication 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 Performance Competencies

WORK ENVIRONMENTWhen 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 :

Any specific skill / certification / license : Prior medical only desk level handling is a plus / AZ lisc. or certification is a plus

Years of experience : yrs or more of direct claim handling or applicable transferable skills in the claims industry.

Work location : Remote within Arizona

EEO :