Med-Only Claims Specialist at MRA Recruiting Services

Under the general supervision of the Worker’s Compensation Claims Manager, this position is responsible for investigating, processing, and adjusting med-only worker’s compensation claims.

WHY JOIN THE CVMIC TEAM:

• The ability to make a difference to internal and external customers!

• Great variety in what you do each day in a fast-paced environment

• Flexibility with your schedule

• A supportive team environment

• Outstanding benefits that include:

  • Company-paid retirement contribution into a SEP Plan (12.1% of salary, after one year of employment)

  • Company-paid health insurance monthly premiums

  • Tuition reimbursement for continuing education

• View what employees say about working here!

Essential Duties & Responsibilities

• Sets up new medical-only files for handling.

• Investigates and processes payments on medical-only claims in an accurate and timely manner; investigates and processes payments.

• Reviews first report of injury forms (WC-12) and follows up with claimant, insured, medical providers, or others in a timely manner to determine compensability.

• Enters workers' compensation claims information into Origami (Claims System) in an accurate and timely manner.

• Interviews, telephones, or corresponds with member representatives, member employees, supervisors, claimants, witnesses, and medical personnel; reviews medical and hospital records in a timely manner to determine compensability while maintaining required confidentiality.

• Maintains and updates claim files with current diaries, file notes, and treatment plans in the claims system.

• Reviews and pays medical bills; Submits medical bills for third-party review.

• Researches and resolves medical bills billed to the claimant or sent to collection on the claimant’s behalf.

• Processes and releases payments for Incentive Program to claimants.

• Monitors claims to identify and follow-up on subrogation opportunities.

• Refers chiropractic claims to a chiropractor for review.

• Handles or refers telephone, written, and e-mail inquiries from members and others.

• Composes and edits routine correspondence.

Other Duties & Responsibilities

• Attends Restitution Hearings.

• Learning and maintaining knowledge of the Medicare (CMS) process and identifying claims that are eligible.

• Assists the Administrative Assistant as needed.

Qualifications

• High school diploma and the equivalent of one year of technical or business school training; and

• One to three (1 – 3) years related experience, or equivalent combination of education and experience.

Knowledge, Skills & Abilities

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Knowledge of:

• Wisconsin Worker’s Compensation Act, administrative code, and case law.

• Claims handling practices and procedures.

• Office machines and proficiency in the use of computers and computer software including Microsoft Word, Outlook, Excel, claims software (Origami), and other business software.

• Medicare.

Ability to:

• Handle sensitive situations in a professional manner that reflects favorably upon the member and the Company.

• Effectively manage multiple assignments or tasks.

• Effectively work as a member of a team, coordinating and completing assignments in a timely manner.

• Communicate professionally, timely, and effectively, both orally and in writing.

• Read and accurately interpret documents such as medical records and legal documents.

• Accurately and efficiently write routine reports and correspondence.

• Effectively and professionally present information and respond to questions from clients, claimants, medical service providers, and member representatives.