Medical Only Claims Trainee

Accident Fund Company of America • Lansing, MI • 5h ago

SUMMARY:

This is an entry-level position. This position leads to a Medical Only Claims Specialist I and is expected to last up to 12 months. Upon completion of the training plan the incumbent is expected to be proficient with the Medical Only Claims policies, processes, procedures, and terminology related to the job. In addition, the incumbent will be proficient in the job responsibilities and tasks of the Medical Only Claims Specialist I position description. The incumbent will be evaluated on their progress and successful completion of the training plan each quarter. Upon satisfactory completion, the incumbent will be eligible for the Medical Only Claims Specialist I position. Medical Only Claims Associate will work with all members of the team and may receive direction, support, and instruction from the Manager or Medical Only Claims Specialists depending on the assignment.

PRIMARY RESPONSIBILITIES:

Assist Medical Only Claims Specialist with the investigation and management of workers compensation claims.

Assists with determining and managing the on-going medical treatment program including directing care, creating panels, and approving provider requests.

Evaluates medical reports and correspondence for appropriate action/documentation.

Supports the customer service work and processes for the multi-functional claims team; Communicates and collaborates with team members to ensure the appropriate and timely handling of claims in other states.

May be required to act as a back up to the MOCS. For items such as Verifies workers' compensation coverage of employers and injured employees.

Documents specifics of claims with potential for subrogation.

Approves payment based on knowledge of the treatment plan and medical support showing relationship of treatment to the injury.

Concludes and closes files following resolution of claims to meet internal performance standards while complying with state legislation to avoid penalties and manage expenses.

Coordinates with outside vendors to ensure cost containment efforts.

Establishes and maintains effective working relationships with all internal and external customers. Assists with determining appropriate response to regulatory inquiries.

Composes correspondence and various reports in the administration of workers compensation claims; sets appropriate diaries.

Reads, routes and keys incoming mail, runs reports and answers/responds to incoming phone calls on both direct and ACD line, faxes and emails. This may include completing 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.

This description identifies the responsibilities typically associated with the performance of the job. The percentage of time in any responsibility may vary between positions. Other relevant essential functions may be required.

A. EDUCATION REQUIRED:

High school diploma

B. EXPERIENCE REQUIRED:

2 years insurance experience ( 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.

C. SKILLS/KNOWLEDGE/ABILITIES (SKA) REQUIRED:

General knowledge of insurance operations.

Ability to work effectively in a multifunctional business unit.

Excellent verbal and written communication skills.

Ability to use diplomacy, discretio

Similar Jobs

Health Information Operations Manager

Datavant • Lansing, MI • 14h ago

Hospital & Medical

Datavant is a data platform company and the world's leader in health data exchange. Our vision is that every healthcare decision is powered by the right data, at the right time, in the right format. Our platform is power...

14h ago

Go to Apply

Pharmacy Customer Service Associate

Walgreens • Dewitt, MI • 14h ago

Hospital & Medical

Job Description: Models and delivers a distinctive and delightful customer experience. Registers sales on assigned cash register, provides customers with courteous, fair, friendly, and efficient checkout service. In acco...

14h ago

Go to Apply

Physical Therapist PT Home Health - Up to $7500 Sign On

Elara Caring • Dewitt, MI • 2d ago

Hospital & Medical

At Elara Caring, we have a unique opportunity to play a huge role in the growth of an entire home care industry. Here, each employee has the chance to make a real difference by carrying out our mission every day. Join ou...

2d ago

Go to Apply

Medical Director

Grifols Shared Services North America, Inc • Lansing, MI • 1w ago

Hospital & Medical

Would you like to join an international team working to improve the future of healthcare? Do you want to enhance the lives of millions of people? Grifols is a global healthcare company that since 1909 has been working to...

1w ago

Go to Apply

Nurse Clinician I

Michigan State University • East Lansing, MI • 1w ago

Hospital & Medical

Position Summary This is a half-time position with benefits working as a Registered Nurse at MSU's Student Health Center. Medical review of questionnaires for Occupational Health. Direct support staff for clinic operatio...

1w ago

Go to Apply

Physical Therapist (PT)

Genesis Healthcare • East Lansing, MI • 1w ago

Hospital & Medical

Overview At Powerback, we're on a mission to improve lives. As the leader in physical, occupational, speech, and respiratory therapies, we help older adults stay active and thrive while providing essential therapy for ch...

1w ago

Go to Apply

Nursing Simulation Educator / Educational Program Coordinator II

Michigan State University(MSU) • East Lansing, MI • 1w ago

Hospital & Medical

Working/Functional Title Nursing Simulation Educator Position Summary The Michigan State University (MSU) College of Nursing (CON) is seeking applications for a Nursing Simulation Educator for our East Lansing campus. Th...

1w ago

Go to Apply

Sim Health Care Provider - Variable Rate

Michigan State University(MSU) • East Lansing, MI • 1w ago

Hospital & Medical

Unit Position Summary In a clinical-like setting (in-person or online), facilitates simulation learning activities similar to what learners would encounter in actual clinical settings. Healthcare providers working in sim...

1w ago

Go to Apply

Community Health Representative III - Maternal and Child Health Division

Ingham County Human Resources • Lansing, MI • 1w ago

Hospital & Medical

Description (Employees in this position will perform the following general tasks and duties in working in various clinics. Not all clinics will perform the same duties or tasks, and employees will have specific tasks ass...

1w ago

Go to Apply

Dentist

Ingham County Human Resources • Lansing, MI • 1w ago

Hospital & Medical

Under the general direction of the Dental Director in collaboration with the Health Center Administrator, he/she diagnoses dental disease or injury, establishes treatment, planning, performs fillings, extractions and rel...

1w ago

Go to Apply

Subscribe to get new jobs sent directly to you
(no charge, cancel anytime)

This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.