Claims Associate

PRIMARY PURPOSE OF THE ROLE

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 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.
• Performs other duties as assigned.
• Supports the organization's quality program(s).

Qualifications

Education & Licensing

• One (1) year of general office experience or equivalent combination of education and experience required.
• Claims industry experience preferred.
• High school diploma or GED required.
• Licenses as required.

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 Environment Requirements

• Physical: Computer keyboarding
• Auditory/visual: Hearing, vision and talking
• Mental: Clear and conceptual thinking ability; excellent judgement and discretion; ability to meet deadlines.