Medical-Only Claim Representative-Workers' Compensation

SFM Mutual Insurance Companies•Brookfield, WI

13d•Remote

About The Position

Medical Only Claim Representative - Remote - Must live in Wisconsin to be considered SFM – The Work Comp Experts Work somewhere you love SFM is unique in that we are small enough that your voice is heard, but has all the benefits and perks of a larger employer. We value your opinion, help you reach your goals, and make it easy for you to maintain work-life balance. SFM is committed to creating the best work environment and believes that our exceptional and motivated employees are our greatest strength. SFM emphasizes work life balance, and our benefit package is designed to assist you navigate your work-life journey. Our benefits include: Affordable Medical, Dental, Vision Insurance, HSA, FSA Traditional and Roth 401(k) plans with company match Company contributions to help pay off student loans Monthly home internet allowance Free life insurance, STD & LTD Opportunities for annual gainshare bonus Pet insurance Generous PTO 9 paid holidays Paid parental leave Annual company-wide volunteer day Discounts on gym memberships, fitness apps and weight loss programs Adoption financial assistance Visit our careers page to learn more about working at SFM . The role At SFM, the Medical Only Claims Representative investigates workers' compensation claims to assess whether medical treatment for injured workers is compensable. SFM is committed to providing you the training you need to be successful in this role and will help you develop your skills to grow professionally. This position is a great way to jump start your career at SFM and learn the ins-and-outs of claims handling. In this position, you will work with employees, employers, and medical providers to pay medical benefits according to the State's guidelines and SFM’s best practices with the goal to provide a successful resolution of a workers' compensation claim. Using your strong communication skills and critical thinking skills, you will focus on delivering excellent customer service to all parties involved in the claims process. Working collaboratively within a multifunctional team is what makes SFM unique and creates a strong team setting. SFM offers a work environment designed to support flexibility and our benefit options are fashioned so you area able to manage your work-life journey and can bring the best version of yourself to work each day!! Applicants must live in Wisconsin to be eligible for this job.

Requirements

Associate’s degree or two years’ business experience, preferably in an insurance environment or medical office.
Ability to maintain confidentiality.
Must be detailed oriented.
Excellent customer service skills, and the ability to work well within a team environment.
Excellent problem solving and decision making skills.
Strong verbal and written communication skills.
Ability to conduct research, assimilate and interpret complex information from a variety of sources.
Ability to work in a fast paced environment and manage multiple projects and deadlines with limited supervision.
Effective conflict resolution skills.
Basic mathematic skills.
Proficient in MS Office software applications (Excel/Word, etc.).
Applicants must live in Wisconsin to be eligible for this job.

Nice To Haves

One or more years handling casualty claims, PIP claims or workers’ compensation claims, preferred.

Responsibilities

Manages medical-only claims files as assigned by setting up new losses, setting future tasks, requesting medical records and itemized statements, making contact with the policyholder and injured worker and entering necessary file comments into the database.
Determines and explains coverage.
Works with EEs, physicians, nurses, attorneys within a multifunctional team environment.
Approves medical bills that correspond with files, which includes verifying adequate reserves, reviewing for compensability and application of any applicable treatment parameters.
May negotiate settlements.
Identifies subrogation or fraud opportunities and refers claim to SIU department for follow-up.
Makes use of company resources to maintain and control costs.
Uses foresight and recognizes the need to consult with or transfer claims back to lost time claims representative if claim is expected to exceed reserve limits, involve a claim for indemnity benefits or involve disputes unable to be resolved.
Takes advantage of learning opportunities to develop, update and expand skills, knowledge and abilities, and applies learning.
Keeps apprised of workers’ compensation rules and regulations and company best practices.
Regularly interacts with team members, policyholders, agents, legal counsel, physicians, nurses, and injured workers to achieve individual team goals.
Maintains appropriate interactions with both internal and external customers
Identifies and communicates trending and claims management practices that could impact the team’s book of business from both an MO perspective and overall team perspective.
Proactively manages claim inventory to ensure all assigned claims are handled to completion in a timely fashion, including follow-up contacts, bill payment, etc., compliant with regulatory requirements