Job Description

Job Title: Claims Examiner

(Hybrid)

Location: Spring Valley, NY 10977

Job Summary:

We are seeking a Medical-Only Claims Examiner to join our team in a hybrid work environment. The ideal candidate will have experience in workers' compensation claims management, particularly focusing on medical-only claims. The position requires proficiency in reviewing medical reports, treatment plans, and bills, as well as ensuring timely and accurate processing of medical expenses in compliance with applicable workers' compensation laws and insurance policies.

What You Will Be Doing:

• Adjust medical-only claims by completing 3-point contact, reviewing medical reports, treatment plans, and bills, ensuring timely processing and payment of medical expenses.
• Process claims in compliance with workers' compensation laws, company guidelines, and insurance policies.
• Review medical records and treatment plans to determine coverage eligibility and appropriate care.
• Communicate with healthcare providers to obtain necessary medical information, authorizations, and treatment updates.
• Process medical bills and coordinate with appropriate parties to ensure accurate and prompt payments, maintaining accurate claim files.

Experience and Qualifications:

• Education: High School Diploma or equivalent required (Associate's or Bachelor's degree preferred).
• Experience:
• 2-3 years adjusting workers' compensation claims in multiple jurisdictions (NY/NJ experience required; NY, NJ, PA experience preferred).
• Previous experience in workers' compensation claims management, specifically medical-only claims, is preferred.
• Healthcare industry experience is preferred.

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