Claim Specialist II
5 days ago
The experience expected from applicants, as well as additional skills and qualifications needed for this job are listed below.
The Claim Specialist II investigates, evaluates, negotiates, and resolves lost time claims and medical-only claims within settlement and reserving authority up to stated maximum. (Supervisor will determine actual individual authority up to the stated maximum). Conducts training classes (including research and position papers) for less experienced Claim Department Representatives. Based on experience and proven ability, an expanded and more difficult caseload will be expected, requiring a lesser degree of supervision.
Communicates with insureds, injured workers, agents, brokers, witnesses, attorneys, loss prevention, and underwriters to obtain and relate necessary information to determine coverage/compensability, facts of loss, and degree of liability/exposure. Maintains contact throughout the life of the file as needed.
Administers the delivery of timely, appropriate and accurate indemnity and medical benefits.
Evaluates claim exposure, negotiate and resolve claims. Works closely with defense counsel on litigated cases and attend mediation, arbitration, and hearings, as necessary. Develops litigation plan with defense counsel and tracks adherence to plan in order to control legal expenses and assure effective resolution.
Works closely with insureds and employees making visitations and presentations as needed to facilitate partnership approach to claims handling.
Maintains quality claim files in accordance with appropriate best practices, and other company procedures.
Implements Managed Care strategies, coordinate rehabilitation or medical management, process bills, review all mail through Image Right, and monitor progress as appropriate.
Interacts with State and Federal Boards and Commissions, while establishing and maintaining proper reserves, as appropriate.
Keeps up-to-date on State laws and Company procedures relating to various claims; educates injured worker and/or insured on same.
Prepares and presents files for Agent/Broker Reviews and Insured File Review.
Understands medical terminology and standard medical procedures as they pertain to worker's compensation, U.S. Longshoreman's and Jones Act claims.
Participates in in-house and outside training programs to keep up-to-date on relevant issues/topics.
Maintains a working knowledge of all computer systems currently in use.
Travels throughout States as required to handle claims inventory assigned.
Continues education in claims through Associate in Claims or Claims Law (AEI) courses.
Requirements:
Two years of workers' compensation claim handling experience preferred.
Bachelor's degree preferred.
Computer skills, Word, Excel and Image Right preferred.
Must have valid driver's license.
Strong attention to detail and strong communication skills both verbal and written.
Adaptable/flexible and self-directed with the ability to manage time and other resources wisely.
Must have the ability to work effectively with other organizational team members.
Our comprehensive benefits package includes all traditional offerings such as:
Health Insurance options, Dental Insurance options and Vision Insurance
Employee Life Insurance/AD&D and Dependent Life Insurance options
Short-term & Long-term Disability
Health Savings Account with potential employer match
Flexible Medical and Dependent Care Account
Accident Insurance
Critical Illness Insurance
Employee Assistance Program
Legal/Identify Theft Insurance options
Long Term Care Insurance
Pet Insurance
401 (k) Retirement Plan with match up to 5%, plus profit sharing & discretionary contributions (subject to vesting)
5 weeks of Paid Time Off (PTO)
10 paid holidays
We also offer other benefits to help foster a healthy, balance lifestyle such as:
Flextime schedules
Paid Parental Leave
Student loan paydown and refinancing assistance
Educational assistance for job related courses, seminars, certifications or degrees
One paid day every year to volunteer for your non-profit of choice
On-site fitness center (Maine & Virginia) or fitness reimbursement
Subsidized parking
Sit-Stand desks & daily stretch breaks
MEMIC is committed to a policy of nondiscrimination and equal opportunity for all employees and qualified applicants without regard to race, color, religious creed, national origin, ancestry, age, disability, genetics, gender identity, veteran's status, sexual orientation, or any other characteristic protected by law. MEMIC is an equal opportunity employer encouraging diversity in the workplace.
MEMIC's Job Applicant Privacy Notice
#IND2022
-
Claims Professional
6 days ago
Portland, United States CorVel Enterprise Comp, Inc. Full timeAbout the RoleCorVel Enterprise Comp, Inc. is seeking a skilled Claims Specialist to join our team. This role involves managing claims within company best practices, ensuring efficient resolution and adherence to delegated authority limits.Key Responsibilities:Receive and process claims, verifying policy coverage and claim acknowledgment.Determine claim...
-
Medical Only Claims Specialist
2 months ago
Portland, United States CorVel Corporation Full timeThe Medical Only Claims Specialist manages non-complex and non-problematic, medical only claims and minor lost-time workers’ compensation claims under close supervision, supporting the goals of claims department and of CorVel. This role is open for remote, hybrid, or onsite work. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Receives claims, confirms...
-
Insurance Claims Specialist
3 days ago
Portland, Tennessee, United States State Farm Insurance Full timeEstimated Salary: $55,000 - $65,000 per year. As an Insurance Claims Specialist at State Farm Insurance, you'll be responsible for processing claims, providing accurate information, and ensuring seamless customer interactions.
-
Claims Operations Specialist
7 days ago
Portland, Oregon, United States City of Portland Oregon Full timeJob OverviewCareer Opportunities at City of Portland OregonThe City of Portland Oregon is committed to providing excellent service to our citizens and visitors. As a Claims Operations Specialist, you will play a critical role in supporting the delivery of high-quality services to the community.CompensationEstimated Annual Salary: $55,000 - $65,000Job...
-
Compensation Claims Specialist
2 days ago
Portland, United States CorVel Enterprise Comp, Inc. Full timeJob OverviewWe are seeking a highly skilled Compensation Claims Specialist to join our team at CorVel Enterprise Comp, Inc. in Portland, OR.
-
Claims Specialist
1 week ago
South Portland, United States Fedcap Rehabilitation Services Full timeFamilies Forward, a member of The Fedcap Group, is looking for a reliable, detail oriented, and adaptable finance professional to join our team as a Claims Specialist! The hired person will partner with finance supervisors, managers, and senior leadership across departments, resolving compliance issues, account discrepancies, and optimizing processes....
-
Claims Specialist
21 hours ago
South Portland, United States Fedcap Rehabilitation Services Full timeFedcap Families, a member of The Fedcap Group, is looking for a reliable, detail oriented, and adaptable finance professional to join our team as a Claims Specialist! The hired person will partner with finance supervisors, managers, and senior leadership across departments, resolving compliance issues, account discrepancies, and optimizing processes. Serious...
-
Medical Claims Specialist
6 days ago
South Portland, Maine, United States InterMed, P.A. Full timeJob Title: Medical Claims SpecialistLocation: Remote/On-Site (dependent on company requirements)About the JobWe are seeking a highly skilled and detail-oriented Medical Claims Specialist to join our team at InterMed, P.A. In this role, you will be responsible for reviewing insurance requirements, patient demographics, and provider information to ensure...
-
Claims Specialist
6 days ago
South Portland, Maine, United States OneAmerica Full timeAbout OneAmericaAt OneAmerica Financial, our purpose is to create more certainty for our customers, which leads to better moments every day. We strive to advance stability and growth in every solution and relationship.Our CommitmentWe are committed to delivering financial strength that builds trust with our clients, partners, and communities. Our commitment...
-
Claims Inventory Specialist
6 days ago
Portland, Oregon, United States Crawford & Company Full timeAbout the RoleWe are seeking a Claims Inventory Specialist to join our team in Portland, Oregon. This is a part-time, hourly position with the potential for full-time work based on performance.Job SummaryThe successful candidate will be responsible for managing assigned claims from initial contact until completion, acting as the single point of contact for...
-
Claims Assistant
2 months ago
Portland, United States CorVel Corporation Full timeThe Claims Assistant will assist and support the claims staff in the set-up and administration of workers’ compensation claims/case management and other tasks depending on the specific needs of the customers. In-office role in Portland, OR. ESSENTIAL JOB DUTIES & RESPONSIBILITIES: Sets up new claims Process mail, handle files (until paperless),...
-
Claims Examiner Specialist
6 days ago
Portland, Oregon, United States Sedgwick Full timeAbout UsSedgwick is a leading global provider of technology-enabled risk, benefits and integrated business solutions. Our mission is to help people regain health and productivity, guide consumers through the claims process, protect brands and minimize business interruptions.Job OverviewThis role involves analyzing high-level Workers Compensation claims on...
-
Portland, United States Opportunities at MEMIC Full timeLocation: Portland, MaineFor a complete understanding of this opportunity, and what will be required to be a successful applicant, read on.Company: MEMIC – Trusted Workers' Compensation Insurance ProviderAbout MEMICAt MEMIC, our mission is to make workers' compensation insurance better—through compassionate service, trusted partnerships, and an...
-
Claims Director
6 months ago
South Portland, United States OneAmerica Full timeJob Details Description At OneAmerica Financial, our purpose is to create more certainty for our customers that leads to better moments, every day. Our commitment is to advance stability and growth in every solution and relationship. We deliver financial strength that builds for generations, and we are always aspiring, looking ahead, and...
-
Portland, United States City of Portland Full timeAbout the Position:Portland Street Response is hiring an Administrative Specialist II to join our Administrative Team. The Admin II will work closely with our Admin III to complete all tasks associated with responder crew scheduling and timekeeping a Administrative Specialist, Behavioral Health, Administrative, Specialist, Healthcare
-
Portland, United States City of Portland Full timeAbout the Position:Portland Street Response is hiring an Administrative Specialist II to join our Administrative Team. The Admin II will work closely with our Admin III to complete all tasks associated with responder crew scheduling and timekeeping a Administrative Specialist, Behavioral Health, Administrative, Specialist, Healthcare
-
Maintenance Technician II Specialist
5 days ago
Portland, Oregon, United States CRMG Full timeCommercial and Residential Management GroupWe are seeking a highly skilled Maintenance Technician II Specialist to join our team. This is a full-time position with an estimated salary of $27.50 per hour.About the RoleThe Maintenance Technician II Specialist will be responsible for performing daily upkeep and cleanliness of buildings, landscaping, amenities,...
-
Human Services Specialist I or II
2 weeks ago
Portland, Maine, United States Commonwealth of Virginia Full timeJob OverviewThe Commonwealth of Virginia is seeking a highly skilled and motivated Human Services Specialist I or II to join our team. This role offers the opportunity to make a meaningful impact in the lives of individuals and families, while developing valuable skills and expertise.
-
Accreditation and Compliance Specialist II
1 month ago
Portland, United States MaineHealth Full timeDescription MaineHealth Corporate Professional - Nonclinical Req #: 3817 This is a 32-hour position, working 5 days a week. The Accreditation and Compliance Specialist II will assist leaders and managers in assessing adherence to accreditation and licensing standards, support efforts to improve and maintain adherence to standards by providing reports to...
-
Accreditation and Compliance Specialist II
7 days ago
Portland, United States MaineHealth Full timeDescription MaineHealth Corporate Professional - Nonclinical Req #: 3817 This is a 32-hour position, working 5 days a week. The Accreditation and Compliance Specialist II will assist leaders and managers in assessing adherence to accreditation and licensing standards, support efforts to improve and maintain adherence to standards by providing reports to...
