Medical Only Claims Representative
New
This position is eligible to work from home anywhere in the United StatesFull-TimeMiddle
Salary46,990 - 71,385 USD per year
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Job Details
- Experience
- One year of insurance or claims handling experience or related experience
- Required Skills
- Customer serviceReportingData entry
Requirements
- Associate degree or equivalent relevant experience (Bachelor’s degree may be considered).
- One year of insurance or claims handling experience or related experience.
- Ability to obtain all applicable state licenses within six months of hire.
- Basic knowledge of the claims adjusting process.
- Good computer skills.
- Strong investigative and problem-solving abilities.
- Ability to multi-task and prioritize deadlines.
- Strong organizational, written, and verbal communication skills.
- Commitment to high standards of professional conduct and ethics.
- Ability to maintain confidentiality.
Responsibilities
- Investigates and evaluates medical only (MO) claims within multiple jurisdictions.
- Reviews claim notices and policies to verify coverage, deductibles, compensability, and jurisdictional compliance.
- Initiates prompt contact with customers, insureds, and witnesses to explain the process and obtain information.
- Sets timely, adequate reserves in compliance with company philosophy.
- Maintains accurate, timely diaries on all files to handle claims and achieve resolution.
- Completes state reporting and secures necessary documents as required.
- Issues timely payments within check authority limits.
- Markets OnCall Nurse, Return to Work, and Select Preferred Provider programs to insureds.
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