Medical Claims Examiner

4 weeks ago

Bradenton, Florida, United States Davies Claims North America Full time
Job Description

About Us

Davies Claims North America is a leading provider of claims services, dedicated to delivering exceptional results for our clients. We believe in creating a learning atmosphere, leadership opportunities, and promoting from within to drive our success.

Job Overview

We are seeking a Medical Only Adjuster to join our team. As a Medical Only Adjuster, you will conduct thorough investigations of assigned workers' compensation claims, provide benefits, and initiate State filings timely while exercising discretion and independent judgement.

Responsibilities and Duties

  • Investigate claims by interviewing claimant, employer, witnesses, and physicians
  • Determine compensability and total value of claim
  • Monitor medical treatment in conjunction with Medical Management personnel
  • Promptly approve medical bills for payment
  • Provide prompt authorization of medical services
  • Coordinate light duty availability with medical providers and employers
  • Maintain adequate reserves for life of claim
  • Convey positive attitude and team spirit for optimum provision of services to customers
  • Attend client meetings as necessary
  • Determine subrogation potential and pursue recovery where applicable
  • Maintain acceptable claim closure ratio
  • Negotiate settlement of claim if warranted
  • Exhibit company values of We are Dynamic, We are Innovative, We are Connected, and We Succeed Together
  • Perform other duties as assigned by the Claims Supervisor, Training Coordinator, Claims Manager, or QA Manager

Experience and Qualifications

Required

  • Sustain working knowledge of workers' compensation law, rules, procedures, case law, liability principles, and medical terminology and procedures
  • Maintain diary and workflow processes
  • Review of claims for possible red flags
  • Identify and pursue subrogation, contribution, indemnification, or other opportunities to compel responsible third parties to bear their share of the settlement burden
  • Must maintain claim closure of at least 97%
  • Reporting of any overall account or client concerns to the supervisor or upper management
  • Must maintain required CEU credits
  • Proficiency in Microsoft Word, Excel, and Outlook
  • Florida All-Lines Adjuster License or Workers Compensation License

Knowledge, Skills, and Abilities

  • Proactive, independent, and takes initiative with consistent follow through
  • Superb communication skills, verbal and written, conducted in a timely manner
  • Superior time management skills with capability of working with and meeting deadlines
  • Exceptional capability to multi-task and prioritize with excellent organization and documentation skills in a fast-paced, dynamic work environment
  • Excellent team player with interpersonal skills
  • High level attention to detail and problem-solving skills
  • Capable of working collaboratively and independently with minimal supervision
  • Exhibit discretion with sensitive and confidential information
  • Display a comfort level working with key people at all levels within an organization

Essential Requirements

  • Must have US work rights
  • Must speak English
  • Must maintain working knowledge of workers' compensation law, rules, procedures, case law, liability principles, and medical terminology and procedures
  • Must maintain required CEU credits
  • Must be proficient in Microsoft Word, Excel, and Outlook
  • Must possess a Florida All-Lines Adjuster License or Workers Compensation License

Benefits

  • Medical, dental, and vision plans
  • 401k plan with employer matching
  • Discretionary Time Off (Vacation & Safety/Sick Leave) and Paid Holidays
  • Life insurance, short term, and long-term disability plans
  • Amazing Executive and Senior leadership as well as fabulous teammates

Position Type, Work Environment and Physical Demands

This is a full-time, hybrid-based position based out of Lakewood Ranch, FL, with the possibility to work remotely from a professional home-based environment, routinely operating and using standard office equipment such as computers, phones, printers, photocopiers, and scanners and requires prolonged periods of sitting at a desk while working on a computer. While performing the duties of this job, the individual will be required to regularly hear and talk. This is a largely sedentary role requiring the ability to sit at a desk, reach outward, use a phone, have use of fingers to operate office equipment such as a keyboard, mouse, phone, printer, copier, and to reach above the head, bend, or stand as necessary.

Location

Davies Claims North America is currently able to support employees residing in the following US locations: Florida, Maryland, D.C., Virginia, Pennsylvania, New Jersey, Delaware, North Carolina, South Carolina, Connecticut, Massachusetts, Rhode Island, New Hampshire, Vermont, Maine, and Texas. If you live in—or are willing to relocate at your own expense to—any of the listed locations, we look forward to your application If there is a required or preferred location for an open role, it will be listed in the job description. Should your state not be listed, please visit https://davies- to locate a subsidiary near you.

  • Property and Casualty Claims Trainee

    4 weeks ago

    Bradenton, Florida, United States Davies Claims North America Full time

    About the RoleWe are seeking a highly motivated and detail-oriented Property and Casualty Claims Trainee to join our team at Davies Claims North America. As a Claims Trainee, you will provide support to our Claims Adjusters, Claims Supervisors, and Claims Managers, while developing skills and knowledge to become a licensed P&C Adjuster.Key...

  • Workers' Compensation Legal Adjuster Position

    4 weeks ago

    Bradenton, Florida, United States Davies Claims North America Full time

    Job DescriptionAbout Davies Claims North AmericaWe are a specialist professional services and technology firm working in partnership with leading insurance, highly regulated, and global businesses. Our team helps clients to manage risk, operate core business processes, and to transform and grow.Job OverviewWe are seeking an experienced Workers' Compensation...

  • Medical Coding Specialist

    4 weeks ago

    Bradenton, Florida, United States MCR HEALTH INC Full time

    Why MCR Health?A career at MCR Health offers exciting opportunities with one of the largest Healthcare companies in the areas we serve. Now, more than ever, we are looking for exceptional people to support our passion to provide exceptional care to everyone, every time, and to support our mission to serve everyone. Whether you are providing direct patient...

  • Durable Medical Equipment Specialist for Podiatry

    1 month ago

    Bradenton, Florida, United States MCR HEALTH INC Full time

    Job Summary:We are seeking a highly skilled Durable Medical Equipment (DME) Specialist to join our team at MCR Health Inc. As a DME Specialist, you will be responsible for processing and submitting DME claims to insurance payors, verifying and/or obtaining pre-authorization for DME, and responding to patients regarding DME billing statements.Key...

  • Medical Assistant

    1 month ago

    Bradenton, Florida, United States MAXhealth Full time

    Job SummaryMaxHealth is seeking a highly skilled Medical Assistant to join our team in Lakewood Ranch. As a Medical Assistant, you will play a vital role in ensuring the delivery of exceptional patient care. Your responsibilities will include preparing patients for examinations, obtaining vital signs, and assisting physicians with procedures.We offer a...

  • Medical Assistant

    4 weeks ago

    Bradenton, Florida, United States MAXhealth Full time

    Job OverviewMaxHealth is seeking a highly skilled Medical Assistant to join our team in Bradenton. As a Medical Assistant, you will play a vital role in ensuring the delivery of exceptional patient care. Your responsibilities will include preparing patients for examinations, obtaining vital signs, and performing administrative tasks such as scheduling...

  • Medical Assistant

    1 month ago

    Bradenton, Florida, United States Millennium Physician Group Full time

    Job Title: Certified Medical AssistantMillennium Physician Group is seeking a highly skilled and motivated Certified Medical Assistant to join our team in the Bradenton area.Job SummaryWe are looking for a Certified Medical Assistant who is positive, energetic, and well-organized, with the ability to multi-task and think outside the box. The ideal candidate...

  • Medical Assistant

    4 weeks ago

    Bradenton, Florida, United States ArchWell Health Full time

    Job Summary:At ArchWell Health, we're seeking a skilled Medical Assistant to join our clinical care team. As a Medical Assistant, you will play a critical role in supporting our Primary Care Physicians (PCPs) in delivering excellent and compassionate primary care to our members. Your responsibilities will include conducting intake with patients, measuring...

  • Medical Care Specialist

    4 weeks ago

    Bradenton, Florida, United States BrightSpring Health Services Full time

    About the RoleWe are seeking a compassionate Nurse Practitioner to join our team at Abode Care Partners. As a Medical Care Specialist, you will provide primary care to seniors and patients with complex needs in various settings, including assisted living and home health partnerships.Key Responsibilities:Perform evidence-based medical care by planning,...

  • Medical Assistant

    4 weeks ago

    Bradenton, Florida, United States MAXhealth Full time

    About the RoleWe are seeking a highly skilled and compassionate Medical Assistant to join our team at MaxHealth in Lakewood Ranch. As a Medical Assistant, you will play a vital role in ensuring the delivery of focused and empathetic patient care.Key ResponsibilitiesPrepare patients for examinations and procedures by obtaining their histories, vital signs,...

  • Medical Assistant

    4 weeks ago

    Bradenton, Florida, United States HCA Florida Blake Primary Care Full time

    Job Summary: We are seeking a skilled Medical Assistant to join our team at HCA Florida Blake Primary Care. As a Medical Assistant, you will play a vital role in providing high-quality patient care and supporting our healthcare team.Key Responsibilities:Prepare patients for examination and treatment by taking vital signs and obtaining medical...

  • Medical Care Provider

    4 weeks ago

    Bradenton, Florida, United States BrightSpring Health Services Full time

    Job Title: Nurse Practitioner - APRNAbout the Role:We are seeking a compassionate and skilled Nurse Practitioner to join our team at Abode Care Partners. As a Nurse Practitioner, you will play a vital role in providing primary care to our patients, working closely with our interdisciplinary team to deliver high-quality, patient-centered...

  • Medical Assistant

    4 weeks ago

    Bradenton, Florida, United States InnovaCare Full time

    Job SummaryThe Medical Assistant plays a vital role in providing high-quality patient care at InnovaCare Health. As a key member of our clinical team, you will be responsible for assisting healthcare professionals with patient examinations, procedures, and administrative tasks.Key Responsibilities:Coordinate patient care activities and schedulesAdminister...

  • Medical Assistant PRN

    4 weeks ago

    Bradenton, Florida, United States MD Now Full time

    We are seeking a skilled Clinical Medical Assistant to join our team at MD Now urgent care. As a Clinical Medical Assistant, you will play a vital role in providing high-quality patient care and supporting our physician-led team of healthcare professionals.Key Responsibilities:Prepare patients for examination and treatment by taking patient histories and...

  • Certified Nurse Midwife

    4 weeks ago

    Bradenton, Florida, United States Lakewood Ranch Medical Center Full time

    Women's Health Specialist OpportunityLakewood Ranch Medical Center's OB/GYN practice is seeking an experienced Nurse Midwife to provide comprehensive healthcare to women throughout the lifespan.Key Responsibilities:Provide prenatal and postpartum care, labor and delivery services, and family planningResponsible for patient education, physical examinations,...

  • Pharmacy Technician

    4 weeks ago

    Bradenton, Florida, United States Walgreens Full time

    Job Description:As a Pharmacy Technician at Walgreens, you will play a vital role in providing exceptional patient care and services. Our pharmacy technicians are the face of our company, interacting with customers and developing strong relationships with patients.We are seeking a highly motivated and detail-oriented individual to join our team as a Pharmacy...

  • Senior Billing Specialist Administration Per Diem Days

    1 month ago

    Bradenton, Florida, United States Foundations for Living Full time

    About the RoleWe are seeking a highly skilled and detail-oriented Billing Specialist to join our team on a per diem basis. As a key member of our administrative team, you will be responsible for managing a broad spectrum of responsibilities and requests related to patient billing and collections.ResponsibilitiesManage billing, claims, and collection support...

  • Interventional Radiology Nurse

    4 weeks ago

    Bradenton, Florida, United States Universal Health Services Full time

    Job Title: Interventional Radiology NurseAt Universal Health Services, we are seeking a skilled Interventional Radiology Nurse to join our team. As a Per Diem Registered Nurse in our Interventional Radiology Department, you will be responsible for providing high-quality patient care and collaborating with our team of healthcare professionals to ensure the...

  • Senior Billing Specialist Administration Per Diem Days

    1 month ago

    Bradenton, Florida, United States UHS Full time

    About the RoleWe are seeking a highly skilled Billing Specialist to join our team on a Per Diem basis. As a key member of our administration team, you will be responsible for managing a broad spectrum of responsibilities and requests related to patient billing and collections.Key ResponsibilitiesManage the billing, claims, and collection support for our...

  • Operating Room Registered Nurse

    4 weeks ago

    Bradenton, Florida, United States HCA Florida Blake Hospital Full time

    We are seeking a highly skilled Operating Room Registered Nurse to join our Surgical Services Department at HCA Florida Blake Hospital. As a key member of our team, you will provide clinical expertise to ensure all patients receive high-quality, efficient care in a surgical environment.As an Operating Room Registered Nurse, you will assess, plan, intervene,...