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TPA 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.

Job ID:

20162

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