Workers' Compensation Claims Specialist

Job Summary

Managing a high-frequency desk, the full-time Medical Only Claims Specialist, Workers' Compensation will investigate, evaluate, and determine compensability for medical-only claims across multiple jurisdictions while working remotely.

Key responsibilities

• Gathers relevant facts through thorough claim investigations and performs three-point contacts with involved parties
• Decides claim outcomes using established policies and guidelines, and evaluates action plans for managing benefits
• Collaborates with various stakeholders to promote quality medical care and manage claims costs effectively

Required qualifications

• Bachelor's Degree from an accredited college or university is preferred
• One year of experience in insurance, claims investigation, or medical claims processing is required
• Workers' compensation claims experience and licensure preferred
• Must pass the claims adjuster license exam(s) within 6 months of hire
• Preference for candidates with multiple state claims management experience