This is a Fully Remote Job
About Our Client:
This organization operates within the workers' compensation insurance sector, focusing on managing claims related to medical-only and limited lost time injuries. They address the challenge of minimizing losses on claims while ensuring compliance with jurisdictional requirements and providing effective claims management.
About the Opportunity:
The ASSOCIATE CLAIMS SPECIALIST role is responsible for proactively managing medical-only, limited lost time, and permanent total claims to minimize financial losses and ensure compliance with relevant regulations. This position plays a key part in maintaining customer service quality and supports the claims process by handling payments, authorizing treatments, and coordinating with medical providers.
Responsibilities:
Contact accounts on First Notices of Loss to gather necessary information for file setup
Process payments, answer calls, and authorize treatment for Medical Only claims
Complete initial contacts within 24 hours and establish follow-up schedules
Assess appropriateness and causal relation of treatments to compensable injuries
Redirect treatment to network physicians when appropriate
Refer claims with subrogation or permanency potential to supervisor
Ensure compliance with jurisdictional requirements, including timely form filing
Maintain knowledge of jurisdictional requirements and obtain/maintain necessary state adjusting licenses
Administer benefits for Permanent Total or Death cases, monitoring for status changes and cost increases
Uphold the organization's Code of Business Conduct and Ethics and comply with relevant policies, procedures, and laws
Requirements:
High school diploma or equivalent
One or more years of Workers Compensation claims handling experience
Required license or ability to obtain license within 90 days of employment in mandated states
Familiarity with medical terminology
Ability to work independently, multitask, make decisions, and maintain attention to detail
Strong organizational skills
Excellent verbal and written communication skills
Proficiency in MS Excel and MS Word
Ability to work remotely
Pay Range and Compensation Package:
Target Salary - $58,000 - $73,000
Equal Opportunity Statement:
Our client is an equal opportunity employer. They celebrate diversity and are committed to creating an inclusive environment for all employees. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, or national origin.
Note:
TalentHop is a recruitment partner of this role. Please note that all employment decisions, including candidate assessment, interviews, hiring, compensation, and employment terms, are made exclusively by the hiring employer.