Insurance Claims Processor
We currently have an opportunity for a large healthcare services provider located in Egg Harbor Township, NJ This is a rapidly growing industry and they urgently need a qualified Claims Specialists to help the business continue to grow! Please take a look at the qualifications below and if interested please contact me immediately at Hailey.email@example.com
Confirm coverage and applicable insurance policy or coverage document and statutory requirements.
Oversee and coordinate medical treatment for injured employees and provide information to treating physicians regarding employees??? medical history, health issues, and job requirements; provide direction to assigned nurse case manager where applicable.
Establish compensability status through case investigation and evaluation and application of jurisdictional statutes and laws. Ensure timely denial or payment of benefits in accordance with jurisdictional requirements.
Establish claim reserve levels by estimating the potential exposure of each assigned claim, establish appropriate reserves with documented rationale, maintain and adjust reserves over the life of the claim to reflect changes in exposure.
Work directly with employers to facilitate a return to work, either on a full-time or modified duty basis.
Identify potential for and pursue third party recovery, including subrogation, Second Injury Fund or other fund involvement (when applicable) and excess or reinsurance reimbursement. Identify potential for disability or pension credits or offsets and apply same where appropriate.
Manage diary in accordance with Best Practices and complete tasks to ensure that cases move to the best financial outcome and timely resolution.
Where litigation is filed, evaluate exposure and work with defense counsel to establish strong defenses, prepare litigation plan of action, set legal reserve and manage litigation over life of claim.
Close all files as appropriate in a timely and complete manner, maintaining closing ratio as directed by management team.
Working hours: 8:30 AM - 5:00 PM
Confidentiality - Possesses high level and regard for confidentiality.
Dependability - Is trustworthy, reliable and accurate.
Detail Oriented - Focuses on details to obtain a quality work product.
Follows Direction - Acts in accordance with instructions.
Judgment - Forms an opinion objectively and with discretion.
Organization - Is able to plan and carry out activities effectively.
Problem Solving - Evaluates information and situations, approaching and resolving in a timely manner.
Teamwork - Promotes cooperation and commitment within a team to achieve goals.
Time Management - Plans and controls time to effectively accomplish goals.
Work Ethic - Is hard working, diligent, reliable, and has initiative.
Proficient with MS Word
Experience with MS Excel
Computer experience with related claims software
Ecellent verbal and written communication skills
Proven interpersonal skills capable of dealing with all levels of personnel
Exceptional ability to multi-task
Excellent negotiation skills
Superior organizational and decision making skills
High School Diploma or GED required
High School diploma required;
Associate???s or Bachelor???s degree preferred, or three or more years of equivalent work experience required in an insurance, medical/health or legal related industry;
At least 3 years of experience handling workers??? compensation claims required; more experience may be required depending upon complexity of claim pending.
Completion of Workers??? Compensation training courses internally and/or externally in all significant areas affecting Workers??? Compensation claims handling and practices.
Workers??? Compensation licenses, certifications, awards preferred.
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