Medical Only Claims Examiner (Contract) (Remote - TX)

Medical Only Claims Examiner (Contract) (Remote - TX): Job Description: Our Client has an immediate need for a full-time Medical Only Claims Examiner to support their workers' compensation office in Texas. This position is remote as long as the candidate resides in and works out of the state of Texas. The schedule for this position is Monday-Friday at 37.5 hours a week with the option of a flex schedule. The Medical Only Examiner will adjust workers’ compensation medical claims for public entities, ensure timely processing of claims and payment of benefits, managing and directing medical treatment.

• Review daily diary for claim status
• Review medical reports to determine whether additional medical opinions are needed
• Object to unauthorized medical treatment
• Establish contact with employer to review issues
• Respond to inquiries from the employer, employee, doctors, and attorneys
• Establish and maintain appropriate reserves
• Review medical reports
• Evaluate and approve medical procedures and treatment
• Review medical bills for appropriateness
• Discuss appropriateness of medical treatment with medical case manager
• Prepare and present reports to clients
• Close claims appropriately
• Help resolve client billing and payment inquiries
• Investigate complaints from injured workers
• Document and code the claim files and claims system with all relevant information
• Maintain and update action plans within specified time frames
• Provide customer service and support to clients and claimants

Position Requirements:

• High School Diploma or equivalent (GED) required for all positions
• AA/AS or BA/BS preferred but not required
• 1-2 years’ Texas workers’ compensation claims handling experience required
• Knowledge of Texas subscriber workers compensation claims handling procedures and public entity claim nuances.
• The Texas 03 Workers’ Compensation license is required
• The 08 All Lines License is preferred
• Proficiency in determining case value and negotiating settlements
• Understanding of medical and legal terminology
• Completion of Insurance Education Association (IEA) or equivalent training
• Designation with current continuing education hours
• Knowledge of workers’ compensation case law, policies, and procedures
• Mathematical calculating skills
• Proficient in Microsoft Office Suite
• Ability to learn additional computer programs
• Reasoning ability, including problem-solving and analytical skills, i.e., proven ability to research and analyze facts, identify issues, and make appropriate recommendations and solutions for resolution
• Acts with integrity in difficult or challenging situations and is a trustworthy, dependable contributor
• Client operations involve handling confidential, proprietary, and highly sensitive information, such as health records, client financials, and other personal data. Therefore, maintaining honesty and integrity is essential for all roles within the company.

Estimated pay is $28.71 - $34.35 per hour (37.5 hour work week)

• *JSG offers medical, dental, vision, life insurance options, short-term disability, 401(k), weekly pay, and more. Johnson Service Group (JSG) is an Equal Opportunity Employer. JSG provides equal employment opportunities to all applicants and employees without regard to race, color, religion, sex, age, sexual orientation, gender identity, national origin, disability, marital status, protected veteran status, or any other characteristic protected by law.

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