Mayo Clinic · 4 hours ago

Claims Representative - RCS

Rochester, MN

Full-time

Remote

Entry, Mid Level

$22.02/hr - $29.71/hr

3+ years exp

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Responsibilities

Responsible for administration of Short-Term Disability (STD), Family Medical Leave Act (FMLA) and medical only Workers’ Compensation claims including initial review, benefit/liability determination and independent case management.

Must review, analyze and interpret medical records in order to determine eligibility and/or compensability of claims and medical bills.

Must ensure claim administration is in alignment with Mayo Clinic policies, federal regulations, and/or state Workers’ Compensation laws.

Functions as institutional resource for STD, FMLA and state workers’ compensation questions and issues.

Able to work in a fast paced environment.

Must be able to schedule and prioritize work appropriately in order to meet internal, as well as statutory, deadlines.

Participates in the development and enhancement of internal procedures.

Demonstrates excellent customer service skills.

Acts as resource for managers/supervisors as well as injured/ill employees.

May represent Claims Section on internal department committees.

Provide customer service to internal and external customers for issues pertaining to provider payments and refunds, as well as internal financial reconciliations.

Must be able to multitask and cope with demanding workload.

Must be a team player, possess excellent organizational, listening, and human relations skills and be able to work well under pressure.

Qualification

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Claims processingFluent in EnglishMedical terminologyClaim adjudicationBenefit administrationWindowsMicrosoft WordMicrosoft ExcelCPT codingICD-9 codingEDocsLawsonWTKOCM claims databaseKeyboarding

Required

Associate’s Degree plus 3 years’ experience in the insurance, medical or claims processing field or 5 years experience in the insurance, medical or claims processing field.

Qualified candidates must be customer-focused, service-oriented and possess demonstrated skills in teambuilding, communication, decision-making, problem-solving, interaction, coping and versatility.

Fluent in English is a requirement.

Keyboarding experience required.

Preferred

Knowledge of personal computer applications such as Windows, Microsoft Word and Excel, medical terminology, CPT and ICD-9 coding, eDocs, Lawson, WTK, and OCM claims database system is helpful.

Candidates possessing experience with claim adjudication or benefit administration are preferred.