Claims Examiner

Shaker Heights, Ohio

Employer: University Hospitals
Industry: Administrative Support
Salary: Competitive
Job type: Full-Time
What You Will Do
  • Reviews the claim form to insure all of the necessary documentation is provided, and promptly processes all new Workers' Compensation (WC) claims pursuant to department procedures.
  • Reviews medical information filed in support of the claim and makes a decision to approve or deny the claim, and requests additional information when necessary.
  • Insures that all pertinent data is entered into the claims system within 48 hours of receipt.
  • Collaborates with the Nurse Case Manager and Claims Administrator when appropriate to determine allowance of a claim.
  • Establishes appropriate initial reserve.
  • Review all medical bills and processes pursuant to BWC and department policy and procedure.
  • Review and manage temporary alternative duty for medical only claims.
  • Request wage information and calculate benefit rates.

Additional Responsibilities
  • Performs other duties as assigned.
  • Complies with all policies and standards.
  • For specific duties and responsibilities, refer to documentation provided by the department during orientation.
  • Must abide by all requirements to safely and securely maintain Protected Health Information (PHI) for our patients. Annual training, the UH Code of Conduct and UH policies and procedures are in place to address appropriate use of PHI in the workplace.


Qualifications:
Education
  • High School Equivalent / GED (Required)
  • Some college (Preferred)

Work Experience
  • 3+ years of legal, medical or insurance office experience (Required)

Knowledge, Skills, & Abilities
  • WC claims experience. (Preferred proficiency)
  • Medical billing and/or medical terminology experience helpful. (Required proficiency)
  • Ability to function independently and as a team player in a fast-paced environment. (Required proficiency)
  • Detail-oriented and organized. (Required proficiency)
  • Ability to handle multiple tasks simultaneously, prioritize work and meet strict deadlines. (Required proficiency)
  • Excellent communication, telephone, and customer service skills (Required proficiency)
  • Demonstrated ability to use PCs, Microsoft Office suite, and general office equipment (i.e., printers, copy machine, FAX machine, etc.) (Required proficiency)
Created: 2024-09-19
Reference: 240009QX
Country: United States
State: Ohio
City: Shaker Heights