Medical Claims Representative

A company is looking for a Medical Only Claims Representative (Remote). Key Responsibilities Investigates and evaluates assigned medical-only claims, ensuring compliance with regulations and documenting coverage analysis Manages claims by identifying complexities or potential fraud, escalating as necessary, and overseeing medical aspects for cost-effective care Maintains claim reserves, ensures data integrity, and communicates effectively with internal and external customers regarding claim status Required Qualifications High School Diploma or Equivalent is required; Bachelor's degree preferred AIC or other insurance designation is preferred but not required A valid driver's license is required 1+ years of experience in a medical or insurance setting, with a preference for workers' compensation experience

Apr 3, 2025 - 23:02

A company is looking for a Medical Only Claims Representative (Remote). Key Responsibilities Investigates and evaluates assigned medical-only claims, ensuring compliance with regulations and documenting coverage analysis Manages claims by identifying complexities or potential fraud, escalating as necessary, and overseeing medical aspects for cost-effective care Maintains claim reserves, ensures data integrity, and communicates effectively with internal and external customers regarding claim status Required Qualifications High School Diploma or Equivalent is required; Bachelor's degree preferred AIC or other insurance designation is preferred but not required A valid driver's license is required 1+ years of experience in a medical or insurance setting, with a preference for workers' compensation experience