Claims Processor

4 weeks ago

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

Claims Processor

Job Summary:

Responsible for analyzing, verifying, and resolving claim tasks and diaries, and assisting workers' compensation adjusters and medical specialists with initial contacts and follow-ups on claims.

Key Responsibilities:
  • Analyze and process scheduled indemnity benefit payments.
  • Assist adjusters with initial calls on minor claims to document course and scope of employment and compensability.
  • Apply workers' compensation statutes, common law, and filing requirements to assigned tasks.
  • Review and document findings from Index reports, vendor invoices, and medical bills and records.
  • Process payments, determine review needs, and ensure timely and accurate processing of indemnity benefit payments.
  • Assist with state regulatory filing requirements via EDI, state web-based systems, or paper.
  • Maintain a caseload of minor medical claims at peak volume times and resolve assigned claims and tasks in accordance with claim adjustment procedures and service standards.
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.
  • Possess some insurance, legal, and/or medical knowledge.
  • Should be able to sit for prolonged periods of time.
Education and Experience:
  • Must have a high school diploma or equivalent.
  • Must fulfill required adjuster licensing requirements.
  • Bachelor's degree desired.

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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