Medical Claims Specialist - Workers Compensation

Berkshire Hathaway • Omaha, NE

415d • Remote

About The Position

The Medical Claims Specialist at Berkshire Hathaway Homestate Companies is responsible for managing a caseload of workers' compensation medical-only claims from inception to resolution. This role involves completing a Medical Claims Training Program and applying learned skills in a practical setting to ensure claims are handled efficiently and in compliance with legal requirements.

Requirements

• Minimum of High School Diploma or equivalent certificate required.
• Administrative experience in law, medicine, insurance/workers compensation, telephonic communication, or negotiation is useful but not necessary.
• Ability to apply common sense understanding to carry out instructions in various forms.
• Ability to deal with problems involving several concrete variables in standardized situations.
• Proficient in Microsoft Office Suite applications and able to master proprietary software.

Responsibilities

• Successfully completes the Medical Claims Training Program.
• Participates actively in classroom training, demonstrating mastery of subject material.
• Exhibits continuous improvement under supervision in the Medical Claims Unit.
• Learns medical subjects including anatomy, physiology, terminology, pharmacology, causation, nature of the injury, and diagnostic and treatment methodology.
• Learns legal subjects including relevant statutes and regulations.
• Effectively uses computer systems for claims management.
• Develops skills in investigative and persuasive communication, decision-making, and documentation.
• Establishes and maintains communication with clients' contact personnel.
• Determines coverage for new claims and conducts investigations to assess compensability and severity.
• Calculates and adjusts reserves as needed.
• Ensures compliance with legal requirements in claims management.
• Manages claims to successful resolution and fosters positive relationships with other company staff.

Benefits

• Paid Time Off
• Paid Holidays
• Retirement Savings Match
• Group Health Insurance (Medical, Dental, and Vision)
• Life and AD&D Insurance
• Long Term Disability Insurance
• Paid Community Volunteer Day
• Employee Assistance Program
• Tuition Reimbursement Program
• Employee Referral Program
• Diversity, Equity and Inclusion Program

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Industry: Insurance Carriers and Related Activities
• Education Level: High school or GED