JOB PURPOSE:

The Claims Specialist is responsible for managing the day-to-day claims operations.

Pay Range: $20.21/HR - $26.27/HR. It is not typical for an individual to be hired at or near the top of the pay range and compensation decisions are dependent on the facts and circumstances of each case. The specific compensation offered to a candidate may be influenced by a variety of factors including skills, qualifications, experience and location.

KEY RESPONSIBILITIES:

▪ Reviews all new claims and establishes a plan of action to achieve favorable claim resolution.
▪ Reviews claims status, action plans, and reserves consideration of client cost.
▪ Advocates, consults and provides coverage advice to clients as appropriate.
▪ Searches for new Home Care agencies, ATPs, DME companies, etc.
▪ Manages billing, quoting and negotiating rates with adjusters and vendors.
▪ Performs other related duties as assigned.

LEADERSHIP PRINCIPLES BEHAVIORS:

▪ Urgency – maintains a sense of urgency as needed.
▪ Bold – challenges the status quo when faced with obstacles while assisting customers.
▪ Effective listening – stays focused on the moment, clarifies and reflects.
▪ Compassionate – shows understanding and concern for others.
▪ Clear vision – forward thinking.

QUALIFICATIONS, SKILLS AND EXPERIENCE:

▪ Bachelor’s Degree preferred.
▪ Strong communication, analytical and customer service skills.
▪ Ability to prioritize efficiently and remain focused while handling multiple tasks

PHYSICAL REQUIREMENTS:

The physical demands and work environment characteristics described here are representative of those that must be met by an employee to successfully perform the essential functions of the job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

▪ Ability to meet essential functions of the position with reasonable accommodations as necessary.
▪ Prolonged periods of working at a desk and/or on a computer
▪ Ability to work overtime as needed.

Required Skills

•    Attention to Detail: Must thoroughly review medical records, orders, and emails to ensure all aspects of a claim are handled appropriately and as requested. 
•    Communication Skills: Clear and effective communication with insurance adjusters, nurse case managers, medical professionals, vendors, injured workers, and legal teams is essential for facilitating the claim process.
•    Analytical Thinking: The ability to assess complex information, identify trends, and make decisions based on facts is necessary
•    Organizational Skills: Managing multiple claims, tracking deadlines, and maintaining accurate records requires strong organizational abilities to ensure timely and efficient resolution.