Claims Technician-Med Only - Charlotte, NC (Hybrid)

Selective Insurance Company of America•Charlotte, NC

3h•Hybrid

About The Position

Selective Insurance is seeking a Claims Technician-Med Only for our Charlotte, NC location. This is a hybrid role with 2 days in office and 3 days remote. This role will investigate, negotiate, and conclude by settlement or denial assigned medical only claims through telephone and/or written correspondence. These duties are performed consistent with company claims policies and procedures, prescribed authority and standards of performance. All job duties and responsibilities must be carried out in compliance with applicable legal and regulatory requirements.

Requirements

Excellent written and verbal communication skills.
Working knowledge of medical treatment and terms as related to medical only workers compensation claims.
Critical thinking skills to assess compensability of WC claim as it relates to the facts and law regarding medical only claims.
Must have valid state-issued driver’s license in good standing and be able to drive an automobile.

Nice To Haves

High School diploma or equivalent preferred.
Prefer 1-3 year of claims experience.
Prefer 1-3 year of data entry experience.

Responsibilities

Receives assigned claims, verifies coverage and determines course of action.
Establishes initial reserves and sets up claims file for automated claims system.
Investigates claims through telephone or written correspondence with claimants, insureds, attorneys, witnesses and others having pertinent information.
Handles incoming calls and correspondence from insureds, claimants, providers and agents regarding questions or problems associated with claims.
Analyzes information obtained through investigation in order to evaluate claim and determine extent of injury and compensability. Analyzes and considers contributory or comparative negligence for purposes of subrogation.
Evaluates, negotiates and settles non-litigated claims within delegated authority.
Receives, reviews, and approves provider bills that are directly related to the covered injury.
Processes state forms, checks, drafts, releases of denial and completes reporting forms for file.
Documents claim files and maintains control of work through documentation or diary system. Updates MCS on a periodic basis to accurately reflect status of each assigned file.
Must be able to drive an automobile to travel within territory. Car travel represents approximately 0-10% of employee’s time and a valid driver’s license.