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MEMIC · 2 days ago

Associate Claim Specialist

New York, United States

Full-time

Onsite

New Grad, Entry Level

$56K/yr - $56K/yr

0+ years exp

MEMIC is a trusted workers’ compensation insurance provider focused on improving workplace safety and claims services. The Associate Claim Specialist is responsible for investigating, evaluating, negotiating, and resolving medical only and lost time claims while maintaining communication with all involved parties.

Financial ServicesInsurance

Responsibilities

Communicates with insureds, injured workers, agents, brokers, witnesses, attorneys, loss prevention, and underwriters to obtain and relate necessary information to determine coverage/compensability, facts of loss, and degree of liability/exposure. Maintains contact throughout the life of the file as needed

Administers the delivery of timely, appropriate medical and indemnity benefits when applicable

Evaluates claim exposure, investigates, negotiates, and resolves medical only and lost time claims with potential for modified duty or periods of total disability

Maintains quality claim files in accordance with best practices, company policy, procedures and state workers’ compensation statutes

Implements Managed Care strategies, coordinates rehabilitation or medical management, processes bills, reviews all mail through ImageRight, and monitors progress as appropriate

Interacts with State and Federal Boards and Commissions, while establishing and maintain proper reserves, as appropriate

Keeps up to date on State laws and Company procedures relating to various claims and educates injured worker and/or insured on same

Participates in in-house and outside training programs to keep up to date on relevant issues/topics

Understands medical terminology and standard medical procedures as they pertain to workers’ compensation

Maintains a working knowledge of all computer systems currently in use

Travels throughout States as required for handling claims inventory assigned

Continues education in claims through WCP, Associate in Claims, or Claims Law (AEI) courses

Qualification

Medical terminologyClaims evaluationNegotiation skillsMicrosoft OfficeSelf-directedAdjuster licensesAttention to detailVerbal communicationWritten communicationTeam collaboration

Required

No previous experience needed; on-the-job training provided

Proficient in Microsoft Office (Word and Excel)

Must have valid driver's license

Strong attention to detail and strong verbal and written communication skills a must

Must have flexibility and be self-directed with ability to manage time and other resources wisely

Must have the ability to work effectively with other organizational team members

If jurisdiction requires, obtain required adjuster licenses within 6 months of employment, or earlier, at manager discretion. Additional licenses may be required throughout course of employment