Claim Specialist

Job Summary We are seeking a dedicated and detail-oriented Claim Specialist to join our claims management team. In this role, you will be responsible for evaluating, processing, and resolving insurance claims efficiently and accurately. Your expertise will ensure fair and timely settlement of claims while maintaining compliance with relevant laws and regulations. The ideal candidate will possess strong analysis skills, excellent customer service abilities, and a thorough understanding of workers' compensation law. This position offers an opportunity to contribute to a dynamic organization committed to integrity, accuracy, and exceptional service. Duties Review and assess incoming insurance claims for completeness and validity, ensuring adherence to company policies and legal standards. Investigate claims thoroughly by analyzing documentation, medical reports, and other relevant information. Detect potential fraud by applying fraud prevention and detection techniques during claim evaluation. Communicate effectively with claimants, healthcare providers, attorneys, and other stakeholders to gather necessary information. Negotiate settlement amounts with claimants or their representatives while balancing fairness and company interests. Utilize financial software to process payments, update claim statuses, and maintain accurate records. Apply auto estimating tools when assessing vehicle damage claims to determine repair costs accurately. Maintain organized files of all claim documentation for audit purposes and future reference. Stay informed about updates in workers' compensation law to ensure compliance in all claim handling procedures. Collaborate with internal teams such as legal, medical review, and customer service to streamline claims processing. Identify opportunities for process improvements to enhance efficiency and reduce processing times.

MUST HAVE

2+ years of Claims processing experience Claims Reimbursement Minimum of 2 years of Claims

ADJUDICATION

experience in ambulatory, acute care hospital, HMO, or IPA environment

Shift Timing :

7AM-3:30PM Weekly schedule: M-F CH1

Job Type:

Contract Pay:

$28.00 - $30.00 per hour

Experience:

Claims processing : 2 years (Required) Claims

ADJUDICATION

: 2 years (Required)

Work Location:

In person