You are applying for a position through Medix, a staffing agency. The actual posting represents a position at one of our clients.
Job Summary
Our client is seeking a skilled Claims Examiner responsible for managing worker's compensation claims. Key duties include processing claims, communicating with stakeholders, evaluating and approving treatments, and negotiating settlements.
Key Responsibilities
- Process new claims in compliance with client’s Service Agreement.
- Establish contact with employer to review issues.
- Respond to inquiries from the employer, employee, doctors, and attorneys.
- Establish and maintain appropriate reserves.
- Review legal correspondence and medical reports.
- Evaluate and approve medical procedures and treatment.
- Administer benefits and ensure appropriateness of all payments.
- Investigate coverage, liability, and monetary value of claims.
- Review medical and legal bills for appropriateness.
- Determine compensability and monitor litigation.
- Negotiate settlement of claim, liens, rehabilitation plans, etc.
- Prepare and present reports to clients and appropriately close claims.
Qualifications
- High School Diploma or equivalent (GED) required; AA/AS or BA/BS preferred.
- Texas 03 Workers’ Compensation license required; 08 All Lines License preferred.
- Completion of IEA or equivalent courses is beneficial.
- Proficient in determining case value and negotiating settlements.
- Understanding of medical and legal terminology.
- Strong verbal and written communication skills.
- Proficient in Microsoft Office Suite.
Experience
- 3+ years of recent workers compensation claims handling experience required.
Skills
- Mathematical calculating skills.
- Excellent organizational skills and ability to multi-task.
- Problem-solving and analytical skills.
Additional Requirements
- Must be able to reliably commute to meetings and events as required.
Benefits
- Paid Sick Leave (Medix provides paid sick leave according to state and local sick leave ordinances).
- Health Benefits / Dental / Vision (Medix offers 6 different health plans: 3 Major Medical Plans, 2 Fixed Indemnity Plans (Standard and Preferred), and 1 Minimum Essential Coverage (MEC) Plan. Eligibility for health benefits is based on verifying that an average of 30 hours per week during the first 4 weeks of the work assignment has been met. If you meet eligibility requirements and take action to enroll, you will be covered no earlier than 60 days into your assignment, depending on plan selection(s)).
- 401k (Eligible on the first 401k open enrollment date following 6 consecutive months on assignment. 401k Open Enrollment dates are 1/1, 4/1, 7/1, and 10/1).
- Short Term Disability Insurance.
- Term Life Insurance Plan.
*We will consider for employment all qualified Applicants, including those with criminal histories, in a manner consistent with the requirements of applicable federal, state, and local laws, including the City of Los Angeles' Fair Chance Initiative for Hiring Ordinance (FCIHO), Los Angeles Fair Chance Ordinance for Employers (ULAC), The San Francisco Fair Chance Ordinance (FCO), and the California Fair Chance Act (CFCA).
Medix Overview:
With over 20 years of experience connecting organizations with highly qualified professionals, Medix is a leading provider of workforce solutions for clients and candidates across the healthcare, scientific, technology, and government industries. Through our core purpose of positively impacting lives, we’re dedicated to creating opportunities for job seekers at some of the nation's top companies. As an award-winning career partner, Medix is committed to helping talent find fulfilling and meaningful work because our mission is to help you achieve yours.
*As a job position within our Insurance division, a successful completion of a background check may be required as a condition of employment. This requirement is directly related to essential job functions including but not limited to: accessing medical and confidential records, verifying financial information, and working within departments that care for vulnerable populations, such as, minors, elderly and those with physical or mental disabilities. Due to these job duties, this position has a significant impact on the business operations and reputation, as well as the safety and well-being of individuals who may be cared for as part of the job position or who may interact with staff or clients
