Claim Administrator

SUMMARY:

Performs support functions and must be willing to serve as entry level claims adjuster responsible for handling a small volume of medical only worker’s compensation claims. This position is an entry-level technical position and works closely with a Senior Claim Adjuster or a Supervisor.   

JOB REQUIREMENTS:

• Receive loss notices via fax or telephone
• Set up claims and forward to adjusters
• Assists adjusters with required state filings, file
• Prepare benefits notes to start WC benefits
• Prepare PQME, IMR, IBR packets
• Maintain appropriate registers
• Complete data entry, check issuance and vouchers
• Maintain policy status information, required logs, and monthly reports
• General clerical duties – i.e. providing support to adjusters by sending faxes, letters, wage statements, contact cards, etc.
• Determines coverage, compensability and if necessary transfers claim
• Utilizes appropriate vendor(s) for medical bill review
• Processes medical payments and all other bills
• Must have basic knowledge of current principles and practices associated with claims investigations
• Must be able to understand oral and written policies, procedures or instructions
• Ability to handle confidential medical information
• Respond to clients in a timely and courteous manner
• May include other assigned duties

REQUIRED KNOWLEDGE, SKILLS AND ABILITIES:

• Ability to understand and follow oral and/or written policies, procedures and instructions
• Ability to perform a wide variety of duties and responsibilities with accuracy and speed, while meeting time-sensitive deadlines
• General knowledge of claims and ability to identify claims of urgent priority
• Must have good oral and written communication skills
• Excellent telephone and customer service skills
• Good understanding of personal computers and ability to use various software
• Ability and willingness to learn new skills and knowledge brought about by rapidly changing information and/or technology

Required Experience: 

Prefer to have 2-5 years experience in claims office or equivalent business experience.   Should have basic knowledge of insurance coverages.  Experience in adjusting MO claims is a plus.  Must have high school diploma or equivalent.