Senior Medical Representative

Progressive • Saginaw, MI

250d • $78,500 - $105,600 • Hybrid

About The Position

As a senior medical representative, you'll analyze and adjust complex medical claims that involve multiple policies. In this role, you'll review and research policy contracts, regulations, and injury causation to make informed coverage decisions. You'll evaluate and resolve economic loss claims, such as attendant care and transportation costs. You'll also interpret medical records, understand medical terminology, and investigate various aspects of claims, including coverage, liability, fraud, and subrogation. Additionally, you'll maintain detailed documentation, adjust reserves based on potential exposure, and complete all necessary tasks to resolve claim files efficiently.

Requirements

• Five years of relevant work experience with two years in claims handling
• OR Associate's degree and four years relevant work experience with two years in claims handling
• OR Bachelor's degree and two years in claims handling

Nice To Haves

• Proficient in coverage and liability investigations
• Experience in catastrophic injury claims handling
• Knowledge of medical coding rules and local statutes

Responsibilities

• Analyze and adjust complex medical claims involving multiple policies.
• Review and research policy contracts, regulations, and injury causation.
• Evaluate and resolve economic loss claims, including attendant care and transportation costs.
• Interpret medical records and understand medical terminology.
• Investigate claims aspects including coverage, liability, fraud, and subrogation.
• Maintain detailed documentation and adjust reserves based on potential exposure.
• Complete all necessary tasks to resolve claim files efficiently.

Benefits

• 401(k) with dollar-for-dollar company match up to 6%
• Medical, dental & vision, including free preventative care
• Wellness & mental health programs
• Health care flexible spending accounts, health savings accounts, & life insurance
• Paid time off, including volunteer time off
• Paid & unpaid sick leave where applicable, as well as short & long-term disability
• Parental & family leave; military leave & pay
• Diverse, inclusive & welcoming culture with Employee Resource Groups
• Career development & tuition assistance

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Industry: Insurance Carriers and Related Activities
• Education Level: Bachelor's degree