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Posted: Tuesday, June 20, 2017 1:49 PM


Claims Specialist Summary

As a Claims Specialist, you will review, analyze and process routine to complex claims within assigned authority limits and consistent with best practice and legal requirements to ensure the delivery of quality service to the customer.

Claims Specialist Responsibilities

Conduct investigations of claims (including such activities as interviewing insured’s, witnesses and claimants, collecting and evaluating appropriate documentation and securing evidence to analyze and confirm coverage and to determine compensability.
Determines and documents, during the investigation process, the potential for subrogation, identifying applicable tortfeasors and promptly placing them "on notice" of the claim.
Evaluates claims for potential fraud.
Assesses compensability associated with claims.
Comply with all legal timeframes associated with the issuance of Bureau prescribed documents and EDI transactions.
Manage a caseload of open claims working to facilitate appropriate medical treatment and timely return-to-work opportunities including transitional duty.

Bachelor's Degree or equivalent experience.
Minimum 5 years relevant experience in Workers Compensation Claims
Effective written and verbal communication skills to provide information in a clear and concise manner and to communicate with a variety of individuals.
Effective analytical skills to gather information analyze facts and make recommendations based upon information collected.
Negotiation skills.
Knowledge of medical terminology and legal processes

Medical and dental coverage
Paid time-off
Flexible spending accounts
Tuition reimbursement
Vision care
Employee and Dependent life insurance
Disability insurance
Job Type: Full-time

Required education:

Required experience:

Workers Compensation Claims: 3 years
Claims: 5 years

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Full Name
Email Address
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• Location: Philadelphia, Philadelphia, Pa

• Post ID: 43479228 philadelphia is an interactive computer service that enables access by multiple users and should not be treated as the publisher or speaker of any information provided by another information content provider. © 2017