TPA Claims Specialist I
General Description: Adjust non lost-time claims for workers compensation
- Knowledge of claims function and processes.
- Ability to effectively communicate with internal and external customers.
- Understanding of workers compensation or disability claims management, strategies, resolution techniques and adjusting.
- Technical/administrative capability to enter first reports of injury and to adjust non lost time claims utilizing the features of the TPA claim management systems.
- Participates in claim advocacy and negotiation, including claim denials, reserving files, and claim reporting, issuing payments and filing of state forms.
- Determine compensability of the claim as it relates to the worker compensation jurisdiction.
- Review and approval of medical services to be paid of the claims file.
Knowledge, Skills and Abilities:
- Ideal candidate will have a minimum of 3 years of claims administration experience.
- College degree preferred but high school diploma or graduate equivalent degree required.
- Proficient in MS Office suite of products.
- Strong written and oral communication skills.
- Ability to work well in a team environment.
- Must have a capacity for analytical thinking and strong problem-solving skills.
- Strong organizational skills required.
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