Medical Claims Specialist

This is an excellent opportunity to be trained into the world of workers’ compensation claims adjusting.  The Medical Claims Specialist is a junior role to the Workers Compensation Claims Adjusters. In this role you will handle light to moderate claims. Your role will allow indemnity adjusters time to focus on more in-depth and complex cases. Workers compensation adjusting is an intellectually interesting and professionally rewarding position that plays a critical role in the success of the company while positively impacting lives. Your strong negotiation and persuasion skills; high aptitude to learn and effectively apply medical and legal principles; and ability to thrive in a challenging and fast paced role are attributes we want on our team.

RESPONSIBILITIES:

• Determine coverage and compensability for reported claims
• Accurately set reserves, ensuring that timely updates are made with claim developments
• Maintain compliance with regulatory deadlines, benefit calculations, state reporting, and benefit notices
• Achieve favorable settlements through timely identification of settlement opportunities; accurate settlement valuations; and effective negotiation practices
• Direct vendors such as field nurses, investigators, defense attorneys to positively impact claims outcomes

REQUIREMENTS:

• Ability to comprehend and learn new workers’ compensation regulations while interpreting complex legal and medical documents.
• Strong verbal and written communication skills with the ability to effectively communicate with a broad audience of varying backgrounds, frequently conveying complicated information in a way easily understood by a layperson
• Working knowledge of Microsoft Word, Excel, with aptitude to learn other software programs

QUALIFICATIONS:

• A keen, logical mind and a strong aptitude for analytical thinking
• Strong oral and written communication skills 
• Rock-solid honesty, openness, and ethical values
• Highly collaborative, ego-free work style; fit into a culture in which people genuinely enjoy working together
• Working knowledge of Microsoft Word and Excel and the ability to rapidly master specialized software programs 
• Bachelor’s degree is a plus but not required

BENEFITS:
Omaha National provides a stable, positive work environment, competitive pay, excellent benefits, such as paid parental bonding leave, tuition reimbursement, 401K, and paid vacation and sick leave.

Summary: The Medical Claims Specialist is a junior role that handles light to moderate workers' compensation claims, allowing indemnity adjusters to focus on more complex cases. This role requires strong negotiation and persuasion skills, as well as the ability to learn and apply medical and legal principles. The ideal candidate will have a keen, logical mind, strong communication skills, and a collaborative work style. A bachelor's degree is a plus, but not required. Omaha National offers a stable work environment, competitive pay, and excellent benefits, including a $300 bonus for fully vaccinated employees. #MedicalClaimsSpecialist #WorkersCompensation #ClaimsAdjuster #NegotiationSkills #LegalKnowledge #AnalyticalThinking #CollaborativeWorkStyle