Claims Representative - Legal (Hybrid)

Mayo Clinic • Rochester, MN

3d • $23 - $31 • Hybrid

About The Position

The Claims Representative administers Short-Term Disability (STD), Family Medical Leave Act (FMLA), and medical-only Workers’ Compensation claims. The role includes initial claim review, benefit and liability determinations, independent case management, and analysis of medical records to determine claim eligibility or compensability and medical-bill eligibility. Claim administration must align 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 issues, and supports managers, supervisors, and employees who are injured or ill. It also provides customer service to internal and external customers regarding provider payments, refunds, and internal financial reconciliations. The representative prioritizes work to meet internal and statutory deadlines, contributes to developing and improving procedures, and may represent the Claims Section on internal department committees.

This role requires strong customer service, organizational, listening, communication, and interpersonal skills, as well as the ability to multitask and work effectively under pressure in a fast-paced environment. The position is hybrid. The vacancy is not eligible for visa sponsorship or transfer and 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.
• Fluent in English.
• Keyboarding experience required.
• Able to multitask, cope with a demanding workload, prioritize work, and perform well under pressure.
• Possess excellent organizational, listening, and human relations skills and work well as a team member.

Nice To Haves

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

Responsibilities

• Administer Short-Term Disability, Family Medical Leave Act, and medical-only Workers’ Compensation claims.
• Perform initial claim reviews and determine benefits and liability.
• Manage cases independently.
• 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 the development and enhancement of internal procedures.
• Provide customer service and act as a resource for managers, supervisors, and injured or ill employees.
• Provide customer service to internal and external customers regarding provider payments, refunds, and internal financial reconciliations.
• Potentially represent the Claims Section on internal department committees.

Benefits

• Multiple medical plan options.
• Dental coverage through Delta Dental or a reimbursement account for flexible coverage.
• Affordable vision plan with a national network.
• HSA and FSA pre-tax savings accounts for eligible expenses.
• Competitive retirement package.
• Continuing education and advancement opportunities.

What This Job Offers

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