Claims Analyst/Adjuster (Little Rock AR or Enid, OK)

Triangle Insurance•Little Rock, OK

16h•Hybrid

About The Position

Responsible for processing workers' compensation claims where the injury or illness is limited to medical treatment. This role provides administrative and technical support to claims adjusters and other team members, ensuring efficient processing of claims. Join our team and immerse yourself in a highly respected organization cemented by a dynamic culture rich with ingenuity and integrity. Our generous compensation packet includes competitive pay, paid time off, exceptional benefits and dual retirement.

Requirements

Ability to read and comprehend simple instructions, short correspondence, and memos.
Ability to write simple correspondence.
Effectively present information in one-on-one and small group situations to customers, clients, and other employees of the organization.
Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals.
Ability to compute rate, ratio, and percentage and to draw and interpret bar graphs.
Effective organizational skills and attention to detail.
Excellent time management skills with a proven ability to meet deadlines.
Proficient with Microsoft Office Suite, Teams, and other internal operating systems.
High School Diploma required.
Adjusters' license in claims is required within the first year of employment.

Nice To Haves

A bachelor's degree with business experience is preferred, or two (2) or more years of past insurance claims experience may be substituted.

Responsibilities

Claim Setup and Data Entry: Receiving new claim information, inputting data into the claims management system, and creating claim files. This may involve gathering initial information from the insured or agent.
Document Management: Organizing, scanning, and indexing claim-related documents (e.g., accident reports, photos, medical records, legal correspondence) and maintaining electronic and physical claim files.
Communication: Answer phone calls and emails from insureds, agents, witnesses, and other parties involved in the claim, providing updates on claim status and answering general inquiries.
Correspondence: Preparing and sending letters, emails, and other correspondence related to claims. This could include requests for information, reservation of rights letters, or settlement offers.
Reporting: Generating reports on claim activity, such as open claims, closed claims, and reserve changes. Tracking key metrics and identifying trends.
File Review: Reviewing claim files for completeness and accuracy. Ensuring all necessary documents are present and that information is correctly recorded.
Support to Adjusters: Assisting claims adjusters with various tasks.
System Updates: Maintaining accurate and up-to-date information in the claims management system.
Other Administrative Tasks: Performing general administrative duties, such as filing, copying, and ordering supplies. Any others as assigned.
Claim Intake and Setup: Receiving and processing First Reports of Injury (FROI) or other claim notifications, setting up new claims in the system, and verifying employee information and employer coverage.
Medical Treatment Authorization: Reviewing medical treatment requests from healthcare providers to determine if they are reasonable, necessary, and related to the work injury. This often involves applying established medical guidelines and utilizing review protocols.
Medical Bill Review: Analyzing medical bills for accuracy, appropriate coding (CPT, HCPCS), and compliance with fee schedules or negotiated rates. Identifying and resolving discrepancies.
Communication: Communicating with healthcare providers to obtain medical records, clarify treatment plans, and discuss billing issues, also with employers and claimants.
Claim Investigation (Limited): While the focus is medical, some investigation may be needed to confirm the injury occurred at work and is compensable under workers' compensation laws. This might involve gathering information about accidents or incident.
Coordination of Care: Working with case managers or nurse case managers (if involved) to ensure appropriate medical care is provided and to facilitate a timely return to work (if applicable, though less common in medical-only claims).
Payment Processing: Authorize and process payments to medical providers for authorized treatment.
Claim Closure: Closing medical-only claims once treatment is complete and all bills have been processed.
Compliance: Adhering to workers' compensation regulations, state-specific guidelines, and company policies.
Documentation: Maintaining accurate and detailed records of all claim-related activities, including medical records, billing information, and communication logs.
Subrogation: Identify and respond to any recovery potential.
Identify and escalate potential fraud.
Provide excellent customer service to all stakeholders.
Regular and sustained attendance.
Perform other duties as assigned.