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Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in processing and adjudicating workers compensation claims, ensuring compliance with industry standards and effective communication with stakeholders. Proficient in managing multiple priorities and maintaining accurate documentation while providing excellent client service.
Highest-signal resume keywords
Workers Compensation Claims ProcessingClaims AdjudicationDocumentation AccuracyClient Relationship ManagementProblem Solving
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Claims CodingMedical Claims AdjustmentReserve MonitoringOffice ExperienceKeyboarding
Soft Skills
Clear ThinkingExcellent JudgmentTroubleshootingDiscretionStress Management
Certifications & Qualifications
High School DiplomaGED
Industry Keywords
Claims Industry ExperienceAdjudication StandardsCompensability DeterminationState Agency DocumentationMultiple Priorities Management
About the role
Key responsibilities & impact- Analyze reported lower-level workers compensation claims to determine benefits due
- Ensure ongoing adjudication of claims within company standards and industry best practices
- Adjust medical-only claims and minor lost-time workers compensation claims under close supervision
- Support claims representatives, examiners, and leads with larger or more complex claims
- Process workers compensation claims, determine compensability and benefits due, monitor reserve accuracy, and file necessary documentation with state agencies
- Communicate claim actions and processing with claimants, clients, and appropriate medical contacts
- Ensure claim files are properly documented and claims coding is correct
- Process routine payments, prescriptions, and status reports for lifetime or defined-period medical claims
- Maintain professional client relationships
Requirements
What you’ll need- High school diploma or GED required
- Licenses as required
- One (1) year of general office experience or equivalent combination of education and experience required
- Claims industry experience preferred
- Clear and conceptual thinking ability
- Excellent judgment, troubleshooting, problem solving, analysis, and discretion
- Ability to handle work-related stress
- Ability to handle multiple priorities simultaneously
- Ability to meet deadlines
- Computer keyboarding
- Travel as required
Benefits
Comp & perks- Flexible work schedule
- Referral incentive program
- Career development and promotional growth opportunities
- Medical, dental, and vision benefits
- 401K on day one