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TPA Lines Claims Specialist I

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General Description:  Adjust non lost-time claims for workers compensation

Responsibilities:

  • 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.

Physical Demands:

Work is performed in a climate controlled office environment with minimal noise and limited to no exposure to chemicals or toxins.  Employees operate office equipment including; telephone - headset, Computer, computer monitors, keyboard, mouse, copier, scanner and mail machine.  Physical tasks of job include; walking, sitting, standing and bending.

Analysis of Physical Demands:

  • Constantly (over 66% of time) work performed requires employees to use repetitive hand motions such as typing, using a keyboard, and sitting at a desk.
  • Frequently (34%-66% of time) work performed requires employees to handle and grasp things, walk on normal surfaces, stand and bend.
  • Occasionally (1%-33% of time) work performed requires employees to drive to client appointments, have repetitive foot movements, walk on uneven or slippery surfaces to and from work and occasionally reach outward to grab things and bend.
  • Rarely  (< than 1 hour per week) work performed  requires Lifting/Carrying  items that range from 10-50lbs, pushing/pulling  items that range from 10-50lbs,  twisting/ turning including reaching over shoulder or above head , kneeling or squatting.



Job ID:

17729

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