Medical Only Claims Specialist

This is a fully remote position, open to applicants in California.

📋 Description

• Receives Workers’ Compensation claims, verifies policy coverage and acknowledges the claim.

• Assesses the legitimacy and compensability of the claim.

• Sets reserves and authorizes payments within the established reserving authority limits.

• Communicates the status of claims to customers, claimants, and clients.

• Follows client and carrier guidelines and takes part in claims reviews as necessary.

• Provides assistance to other claims professionals with more intricate or challenging claims when needed.

• Undertakes additional responsibilities as assigned.

⛳️ Requirements

• Bachelor’s degree or a combination of education and relevant experience.

• At least 1 year of industry experience and claims handling.

• Workers’ Compensation experience is mandatory.

• Licensed as required by jurisdiction.

• Exceptional customer service skills.

• Outstanding written and verbal communication abilities.

• Quick learner; develops knowledge of claims practices, pertinent statutes, and medical terminology.

• Capability to identify, analyze, and resolve problems.

• Computer proficiency and technical aptitude to utilize Microsoft Office, including Excel spreadsheets.

• Strong interpersonal, time management, and organizational skills.

• Ability to work independently as well as collaboratively within a team environment.

🏝️ Benefits

• Medical (HDHP) with Pharmacy.

• Dental insurance.

• Vision insurance.

• Long Term Disability.

• Health Savings Account.

• Flexible Spending Account Options.

• Life Insurance.

• Accident Insurance.

• Critical Illness Insurance.

• Pre-paid Legal Insurance.

• Parking and Transit FSA accounts.

• 401K.

• ROTH 401K.

• Paid time off.

• Remote work.

• Career advancement opportunities.

• Supportive culture.