Claims Representative - Legal (Hybrid)

Mayo Clinic • Rochester, MN

2d • Hybrid

About The Position

Responsible for administering Short-Term Disability (STD), Family Medical Leave Act (FMLA), and medical-only Workers’ Compensation claims, including initial review, benefit and liability determinations, and independent case management. Reviews, analyzes, and interprets medical records to determine claim eligibility or compensability and medical-bill eligibility. Ensures claim administration aligns with Mayo Clinic policies, federal regulations, and applicable state Workers’ Compensation laws.

Serves as an institutional resource for questions and issues involving STD, FMLA, and state Workers’ Compensation. Supports managers, supervisors, and employees who are injured or ill, and may represent the Claims Section on internal department committees. Provides customer service to internal and external customers regarding provider payments, refunds, and internal financial reconciliations. Participates in developing and enhancing internal procedures.

The role requires managing a demanding workload in a fast-paced environment, prioritizing work to meet internal and statutory deadlines, multitasking, and working well under pressure. The selection process may include a pre-recorded OnDemand interview. The vacancy is not eligible for visa sponsorship or transfer, and Mayo Clinic does not participate in the F-1 STEM OPT extension program.

Requirements

• Associate’s degree plus 3 years of experience in the insurance, medical, or claims processing field, or 5 years of experience in one of those fields.
• Customer-focused and service-oriented, with demonstrated skills in teambuilding, communication, decision-making, problem-solving, interaction, coping, and versatility.
• Fluency in English.
• Keyboarding experience.
• Ability to multitask, manage a demanding workload, prioritize work, meet deadlines, and work well under pressure.
• Excellent organizational, listening, and human relations skills, and ability to work well as part of a team.

Nice To Haves

• Knowledge of personal computer applications such as Windows, Microsoft Word, and Excel.
• Knowledge of medical terminology, CPT and ICD-9 coding, eDocs, Lawson, WTK, and the OCM claims database system.
• Experience with claim adjudication or benefit administration.

Responsibilities

• Administer Short-Term Disability, FMLA, and medical-only Workers’ Compensation claims, including initial review, benefit and liability determinations, and independent case management.
• Review, analyze, and interpret medical records to determine claim eligibility or compensability and medical-bill eligibility.
• Ensure claim administration complies with Mayo Clinic policies, federal regulations, and applicable state Workers’ Compensation laws.
• Serve as an institutional resource for STD, FMLA, and state Workers’ Compensation questions and issues.
• Schedule and prioritize work to meet internal and statutory deadlines.
• Participate in developing and enhancing internal procedures.
• Provide customer service to internal and external customers regarding provider payments, refunds, and internal financial reconciliations.
• Act as a resource for managers, supervisors, and injured or ill employees.
• May represent the Claims Section on internal department committees.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: Associate degree