Claims Examiner, Medical Only
- Maitland, FL
- Permanent
- Full-time
- Thrive in a fast-paced setting by juggling multiple tasks and prioritizing effectively.
- Dive into investigating losses ranging from low to moderate severity, pinpointing the cause, scope, and extent of injury or liability for potential subrogation.
- Confirm coverage and ensure all policy conditions are met.
- Gather missing information and guarantee data integrity for seamless regulatory reporting.
- Communicate effectively with claimants, policyholders, underwriters, agents, and other vital internal and external partners.
- Approve medical treatment and seamlessly schedule appointments.
- Set medical reserves, review and approve medical bills, and diligently review/request medical records.
- Keep meticulous claim file notes documenting every correspondence, report, discussion, and decision.
- Knowledge of multi-state jurisdictions (if applicable)
- Ability to obtain appropriate examiner licensing (if applicable)
- Proficiency with MS Word, Excel, and other business applications
- Demonstrated skills in critical thinking and independent decision making
- State licensing requirements (if applicable)
- 2 years handling Medical Only or other Workers’ Compensation claims experience preferred but not required.
- Prior customer service, client support, and/or user assistance experience is a plus
- Basic knowledge of medical conditions, treatment plans and casual relation to occupational injury/illness or ability to learn them
- Drive and desire to use this position as a starting point to potentially enter the Claim Associate training program and become a Lost Time adjuster in the future
- 20 Paid Holidays and 18 days of PTO
- Monday through Friday work schedule – no nights or weekends required
- 401k Savings Plan
- Medical, Dental and Vision Health Benefits – including spouses and children
- Internal Wellness Program with yearly discounts and incentives