Medical-Only Claim Representative-Workers' Compensation

SFM Mutual Insurance Companies•Johnston, IA

6d•$26 - $37•Remote

About The Position

At SFM, the Medical Only Claims Representative investigates workers' compensation claims to assess whether medical treatment for injured workers is compensable. You will play a critical role in evaluating workplace injuries and assist employees and employers throughout the claims process. This position involves reviewing the validity of claims, gathering relevant medical documents and collaborating with the employer and healthcare providers to ensure that the injured workers medical expenses are paid in accordance with the State's guidelines and SFM’s best practices. The goal is to provide a successful and efficient resolution of the claim. You will use your strong communication skills and critical thinking skills, while focusing on delivering excellent customer service to all parties involved in the claims process. Helping people, and making a difference in someone's life is a big part of the responsibilities for this job, as is working collaboratively within a multifunctional team. That team environment is what makes SFM unique. SFM is committed to providing you with the training you need to be successful and 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. Applicants must live in Iowa.

Requirements

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.

Nice To Haves

Bachelor's degree preferred.
Associate’s degree or two years’ business experience, preferably in an insurance environment, medical office, or customer service environment is acceptable.
One or more years handling casualty claims, PIP claims or workers’ compensation claims, preferred.

Responsibilities

Work on a multifunctional team, manage medical-only claims as assigned and determines and communicates findings to the injured worker/ employer, while partnering with medical providers and other key stakeholders.
Investigate claims which involves gathering all relative information for the purpose of determining the validity of the claim.
Approve or deny medical bills associated with the claim, which involves setting/verifying adequate reserves, reviewing for compensability and application of any applicable treatment parameters.
Escalate claims to lost time claims representatives when appropriate if a claim is expected to exceed reserve limits, or involves a claim for indemnity benefits or disputes unable to be resolved.
Apply business unit policies, practices and procedures and provide superior customer service to policyholders, agents, injured workers and team members and ensures compliance of state laws and requirements.
Regularly interacts with team members, policyholders, agents, legal counsel, medical providers and injured workers to achieve timely and fair resolution of claims while delivering excellent customer service.
Documents all actions taken during the claims process.