Claims Processor

2 weeks ago

Fort Wayne, Indiana, United States Brotherhood Mutual Full time
Job Title: Claims Processor

Job Summary:

As a Claims Processor at Brotherhood Mutual Insurance Company, you will play a critical role in effectively analyzing, verifying, authorizing, and resolving claim tasks and diaries. You will assist workers' compensation adjusters and medical specialists with initial contacts and follow-ups on claims, ensuring consistency with claims department standards and company objectives.

Key Responsibilities:
  • Analyze and process scheduled indemnity benefit payments.
  • Assist workers' compensation adjusters with initial calls on minor claims to document course and scope of employment and compensability.
  • Apply workers' compensation statutes, common law, filing requirements, and other applicable legal and regulatory concepts related to assigned tasks.
  • Review and document findings/summary from Index reports, vendor invoices and reports, code for payment, process payment, and determine if review is needed by assigned adjuster.
  • Review medical bills and records, document summary, code for payment, and route to bill review. Request needed/missing medical bills or records, via phone or written request. Review, code, and process or route TPA drafts or approval of payments. Ensure timely and accurate processing of indemnity benefit payments.
  • Assist with state regulatory filing requirements via EDI, state web-based systems, or paper. Ensure timely and accurate processing of regulatory compliance filings within mandated time frame to avoid fines and penalties.
  • Maintain a caseload of minor medical claims at peak volume times. Resolve assigned claims and tasks in accordance with claim adjustment procedures and service standards.
  • Achieve established claim file audit objectives.
  • Ensure the security and accuracy of checks directly issued through the claims processing system.
Requirements:
  • Must be able to effectively communicate with others (both oral and written).
  • Must be able to make independent decisions.
  • Must have strong interpersonal and organizational skills.
  • Must have the ability to handle confrontational situations in a productive manner.
  • Experience in investigation, customer service, and/or negotiation would be beneficial.
  • Possess some insurance, legal and/or medical knowledge.
  • Should be able to sit for prolonged periods of time.
Education and/or Experience:
  • Must have a high school diploma or equivalent.
  • Must fulfill required adjuster licensing requirements.
  • Bachelor's degree desired.
  • Insurance-related course work is desired.

Brotherhood Mutual Insurance Company is an equal opportunity employer.

This job description is intended to describe the general content of and requirements for the performance of this position. It is not to be construed as an exhaustive statement of duties, responsibilities, or requirements.

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