Job Details

Within designated authority, handles medical management claims with limited supervision. This is an in office position, with hybrid flexibility. Duties and Responsibilities Handles first party medical benefit claims, including fatalities and wage loss claims. Evaluates and makes decisions regarding coverage. Conducts investigations, determines total value of claims, sets and maintains adequate reserves, and manages cases. Prepares related correspondence and reports, obtains medical and employment related records, calculates wage loss claims per applicable state laws and brings claims to conclusion. Investigates, evaluates, and resolves coverage questions in compliance with applicable state laws. Establishes immediate contact with Policyholders and Claimants. Contacts Agents as necessary. Reviews claim files on a regular basis and takes necessary follow-up and/or closing action. Evaluates, processes and takes appropriate action on claim-related bills and medical, rehabilitation and spec...Medical, Management, Specialist, Claims, Insurance, Healthcare