Claims Examiner for Medical-Only Cases

2 weeks ago

Pittsburgh, Pennsylvania, United States Babb, Inc. Full time

The Claims Examiner for Medical-Only Cases role offers a full-time opportunity to assess, authorize, and manage workers' compensation claims focused solely on medical aspects.

Key Responsibilities:

  • Evaluate the connection between injuries and medical treatments, ensuring they meet necessary guidelines.
  • Process and approve medical bills and expenses accurately and promptly, adhering to state regulations.
  • Identify potential issues, such as prolonged medical treatments or excessive expenses.
  • Issue denials strictly related to medical concerns and communicate these decisions to relevant parties.
  • Address inquiries from insured individuals and injured workers as needed.
  • Conduct necessary follow-ups with employers within a 24-hour timeframe.
  • Refer cases to nursing professionals for management when deemed appropriate.
  • Initiate referrals for surveillance or medical record tracing when required.
  • Complete necessary state documentation as mandated.
  • Recognize when a Utilization Review (UR) referral is necessary.
Qualifications:
  • Analytical Skills: Ability to identify and analyze problems or opportunities, understanding cause and effect.
  • Decision-Making: Capable of exercising sound judgment and making informed decisions.
  • Communication: Proficient in verbal, written, and listening communication.
  • Investigative Principles: Follows a systematic approach to inquiries to accurately reconstruct events.
  • Value Assessment: Determines liability and assigns financial values based on claims.
  • Legal Acumen: Knowledge of applicable state and federal laws and regulations in the insurance sector.
  • Medical Understanding: Ability to apply specialized knowledge to assess the nature and extent of injuries.
  • Technical Proficiency: Communicates thoughts clearly and concisely in both oral and written formats.
Preferred Attributes:
  • Exceptional customer service abilities.
  • Strong organizational capabilities.
  • Ability to foster and maintain productive relationships.
  • Proficient computer skills.
Educational Requirements:
  • Preferred college degree.
  • 1-2 years of relevant business experience is advantageous.
  • Licensing or certification may be required post-hire based on state regulations.
  • Must pass a pre-employment background check and drug screening.
  • Reliable transportation is necessary.
About BABB, Inc.:

BABB, Inc. has been a trusted partner since 1929, dedicated to the health, safety, and well-being of both its employees and clients. We collaborate with businesses of all sizes to enhance risk management and reduce insurance costs.

As a proud supporter of the Pittsburgh community, BABB offers its employees:
  • Family-oriented values.
  • A historic and beautiful workplace.
  • Complimentary parking.
  • A commitment to personal and professional development.
  • A wellness workout facility.

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