Shire Jobs

Description

We are looking for a Claims Specialist to join our team in Grand Rapids, MI. This role involves handling all aspects of workers compensation lost time claims and maintaining strong customer relations throughout the process. This position offers a short term contract employment opportunity.

Responsibilities:

• Handle all aspects of workers compensation lost time claims from set-up to case closure ensuring strong customer relations are maintained throughout the process.

• Review claim and policy information to provide background for investigation.

• Conduct ongoing investigations, obtaining facts and taking statements as necessary with insured claimant and medical providers.

• Evaluate the facts gathered through the investigation to determine compensability of the claim.

• Inform insureds, claimants and attorneys of claim denials when applicable.

• Prepare reports on investigation, settlements, denials of claims, and evaluations of involved parties.

• Administer statutory medical and indemnity benefits throughout the life of the claim.

• Set reserves within authority limits for medical indemnity and expenses and recommend reserve changes to Team Leader throughout the life of the claim.

• Work with attorneys to manage hearings and litigation.

• Control and direct vendors, nurse case managers, telephonic cases managers, and rehabilitation managers on medical management and return to work initiatives.

• Comply with customer service requests including Special Claims Handling procedures, file status notes, and claim reviews.

• File workers compensation forms and electronic data with states to ensure compliance with statutory regulations.

• Refer appropriate claims to subrogation and secure necessary information to ensure that recovery opportunities are maximized.

• Work with in-house Technical Assistants, Special Investigators, Nurse Consultants, Telephonic Case Managers as well as Team Supervisors to exceed customer's expectations for exceptional claims handling service.

Requirements • Proficiency in Customer Service and Communication skills

• Understanding of Procedures, Policy, Compliance, and Quality measures in medical billing

• Experience in Human Resources (HR) Administration

• Knowledge of Insurance policies, Medical Coverage, and Benefit Functions

• Demonstrated Leadership Skills

• Experience working with Vendors and managing Claim Administration

• Familiarity with Regulation, Expense Reporting, and Financial Notes in the healthcare sector

• Excellent Time Management skills

• Knowledge of Consumer Electronics would be a plus

• Ability to work effectively in a Teamwork environment

• Proficiency in Microsoft Office Suites

• Understanding of Litigation processes related to medical billing

• Familiarity with HealthCare.gov and its functions

• Ability to Ensure Compliance with all relevant laws and regulations.

Robert Half is the world’s first and largest specialized talent solutions firm that connects highly qualified job seekers to opportunities at great companies. We offer contract, temporary and permanent placement solutions for finance and accounting, technology, marketing and creative, legal, and administrative and customer support roles.

Robert Half works to put you in the best position to succeed. We provide access to top jobs, competitive compensation and benefits, and free online training. Stay on top of every opportunity - whenever you choose - even on the go. Download the Robert Half app (https://www.roberthalf.com/us/en/mobile-app) and get 1-tap apply, notifications of AI-matched jobs, and much more.

All applicants applying for U.S. job openings must be legally authorized to work in the United States. Benefits are available to contract/temporary professionals, including medical, vision, dental, and life and disability insurance. Hired contract/temporary professionals are also eligible to enroll in our company 401(k) plan. Visit roberthalf.gobenefits.net for more information.

© 2024 Robert Half. An Equal Opportunity Employer. M/F/Disability/Veterans. By clicking “Apply Now,” you’re agreeing to Robert Half’s Terms of Use (https:///www.roberthalf.com/us/en/terms) .