Claims Representative - Legal (Hybrid)

Mayo Clinic • Rochester, MN

3d • $23 - $31 • Hybrid

About The Position

The Claims Representative administers Short-Term Disability (STD), Family and Medical Leave Act (FMLA), and medical-only Workers’ Compensation claims. The role reviews claims and medical records, determines benefit eligibility and liability or compensability, and independently manages cases. Claim administration must comply with Mayo Clinic policies, federal regulations, and applicable state Workers’ Compensation laws.

The position serves as an institutional resource for STD, FMLA, and state Workers’ Compensation questions, and supports managers, supervisors, and employees who are injured or ill. It also provides customer service concerning provider payments, refunds, and internal financial reconciliations. The representative may serve on internal department committees and contribute to the development and improvement of procedures.

Success in the role requires managing a demanding workload, prioritizing tasks to meet internal and statutory deadlines, and working effectively under pressure. The position calls for strong customer service, organizational, listening, communication, and interpersonal skills, as well as the ability to multitask and work as part of a team.

The selection process may include an OnDemand prerecorded interview. The position 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 insurance, medical, or claims processing, or 5 years of experience in one of those fields.
• Customer-focused and service-oriented approach.
• Demonstrated skills in teambuilding, communication, decision-making, problem-solving, interaction, coping, and versatility.
• Knowledge of personal computer applications, including Windows, Microsoft Word, and Excel, is helpful.
• Knowledge of medical terminology and CPT and ICD-9 coding is helpful.
• Fluent English is required.
• Keyboarding experience is required.
• Ability to multitask, prioritize work, manage a demanding workload, meet deadlines, work under pressure, and work well as part of a team.

Nice To Haves

• Experience with claim adjudication or benefit administration is preferred.
• Knowledge of eDocs, Lawson, WTK, and the OCM claims database system is helpful.

Responsibilities

• Administer Short-Term Disability (STD), 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 assess medical bills.
• 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 while managing a demanding workload.
• Participate in developing and enhancing internal procedures.
• Provide customer service and act as a resource for managers, supervisors, and injured or ill employees.
• Provide internal and external customer service regarding provider payments, refunds, and internal financial reconciliations.
• May represent the Claims Section on internal department committees.

Benefits

• Medical insurance with multiple plan options.
• Dental coverage through Delta Dental or a reimbursement account for flexible coverage.
• Vision plan with a national network.
• HSA and FSAs for eligible expenses.
• Competitive retirement package.
• Continuing education and advancement opportunities.
• Competitive compensation and comprehensive benefit plans.

What This Job Offers

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