Medical Only Claims Trainee

Emergent Holdings•Lansing, MI

4d•Onsite

About The Position

This is an entry-level position designed to train individuals for a Medical Only Claims Specialist I role, with an expected duration of up to 12 months. Upon completion of the training plan, the incumbent is expected to be proficient in Medical Only Claims policies, processes, procedures, and terminology, as well as the responsibilities and tasks of the Medical Only Claims Specialist I. Progress will be evaluated quarterly, and satisfactory completion makes the incumbent eligible for the Specialist I position. The trainee will collaborate with the team and may receive guidance from the Manager or Medical Only Claims Specialists.

Requirements

High school diploma
2 years insurance experience (Could add finance, medical, or any other applicable experience)
Associates degree in insurance, business administration, health administration and/or related field. Combination of education and experience may be considered in lieu of a degree.
General knowledge of insurance operations.
Ability to work effectively in a multifunctional business unit.
Excellent verbal and written communication skills.
Ability to use diplomacy, discretion, and appropriate judgment when responding to inquiries from staff and external customers as well as anticipating needs of the department.
Ability to effectively exchange information clearly and concisely, and present ideas, report facts and other information and respond to questions as appropriate.
Ability to negotiate, build consensus, and resolve conflict.
Excellent organizational skills and ability to prioritize work.
Ability to manage multiple priorities and meet established deadlines.
Ability to perform mathematical calculations.
Excellent analytical and problem solving skills.
Ability to use reference manuals.
Basic knowledge of medical terminology.
Ability to comprehend various issues, address them or refer them for appropriate decision-making.
Ability to work with minimal direction.
Ability to proofread documents for accuracy of spelling, grammar, punctuation, and format.
Reading Comprehension, Typing 35wpm, Basic Word, Math and Proofreading testing.

Nice To Haves

Associates degree preferred
Progress towards or completion of Insurance Institute of America (IIA) or other insurance related designation(s) preferred
Successful completion of probationary period requires adjuster license obtained in either MI or TX.

Responsibilities

Assist Medical Only Claims Specialist with the investigation and management of workers compensation claims.
Assist with determining and managing the on-going medical treatment program, including directing care, creating panels, and approving provider requests.
Evaluate medical reports and correspondence for appropriate action/documentation.
Support customer service work and processes for the multi-functional claims team; communicate and collaborate with team members to ensure appropriate and timely handling of claims in other states.
May be required to act as a back up to the MOCS, such as verifying workers’ compensation coverage of employers and injured employees.
Document specifics of claims with potential for subrogation.
Approve payment based on knowledge of the treatment plan and medical support showing relationship of treatment to the injury.
Conclude and close files following resolution of claims to meet internal performance standards while complying with state legislation to avoid penalties and manage expenses.
Coordinate with outside vendors to ensure cost containment efforts.
Establish and maintain effective working relationships with all internal and external customers.
Assist with determining appropriate response to regulatory inquiries.
Compose correspondence and various reports in the administration of workers compensation claims; set appropriate diaries.
Read, route and key incoming mail, run reports and answer/respond to incoming phone calls on both direct and ACD line, faxes and emails.
Complete work for peers during absences to provide uninterrupted service to customers.
Demonstrate growth of skills working towards the more complex responsibilities of the Medical Only Claims Specialist I position.
Increase knowledge of how Accident Fund Insurance Company of America runs and how Workers Compensation Insurance works.