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About the role
Key responsibilities & impact- Organizes the digital claim records for uniformity by removing duplicate records and top-lining documents
- Completes 10-day and 6-month claim maintenance checklists to ensure the highest level of claims statistical data processing
- Processes corrections to data error crits as required
- Completes manual Medicare query of claims at the CMS COB&R site as needed and documents the digital claim record
- Processes class code corrections that accurately depict the scope of an injured workers’ job and payroll
- Completes claim documents in both ImageRight and Powersuite
- Completes closure, re-opens, and reassignments of all claim files as submitted by Supervisory personnel
- Assists with record subpoenas and completes lien reviews organized with a worksheet summary
- Completes vendor referrals by service specialty and utilization review submissions to Rising
- Maintains contact with the WCAB for status updates on claims where named as a party to suit in error
- Complies with Maximus responses following IMR for timely fulfillment
- Reviews adjuster ImageRight tasks daily for medical authorization requests
- Provides administrative assistance to claim adjusting team members as needed
- Provides back-up in the entry of manual payments to the Claims Payable Analyst
Requirements
What you’ll need- Minimum Education: High School Diploma or equivalent
- Preferred Education: College degree preferred
- 1-2 years of relevant claims processing experience preferable in the worker’s compensation field or similar experience
- Thorough knowledge of workers’ compensation claims procedures and policies
- Professional telephone demeanor, good verbal and written communication skills, good listening skills
- Strong organizational skills
- Ability to type 45 WPM
- Basic understanding of business technology
Benefits
Comp & perks- Comprehensive medical insurance, dental insurance, and vision insurance
- Life and disability insurance
- Fertility benefits
- Wellness resources
- Paid sick time
- Generous paid time off and holidays
- Employee Assistance Program (EAP)
- Complimentary Calm app subscription
- Immediate vesting in a 401(k) plan
- Health Savings Account (HSA) and Flexible Spending Account (FSA) options
- Commuter benefits
- Employee discount programs
- Paid maternity leave and paid paternity leave (including for adoptive parents)
- Legal plan options
- Pet insurance coverage
ATS Keywords
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Hard Skills & Tools
Claims Statistical Data ProcessingData Error CorrectionsManual Medicare QueryClass Code CorrectionsTyping 45 WPM
Soft Skills
Verbal Communication SkillsWritten Communication SkillsListening SkillsProfessional Telephone Demeanor