What are the responsibilities and job description for the Claims Analyst position at Spooner Medical Administrators, Inc.?
Spooner Medical Administrators, Incorporated (SMAI) is a family owned and operated company that offers rewarding career opportunities for motivated individuals who are passionate about excellence and growth. Since 1997, SMAI’s proactive philosophy and best practices have set the standard in workers’ compensation by continuously improving the delivery of case management, utilization review and billing services to help facilitate a successful return to work for the injured worker.
Position Summary:
Telephonically intake work-related injury information to prepare claim for electronic filing with the Ohio BWC. Process claim paperwork for new and existing work-related injuries. Continue to manage medical-only work-related injuries to identify any problems/issues after return to work and build relationships with employers.
Primary Duties & Responsibilities:
1. Review and verify information entered by the Intake Department
2. Initiate contact with injured workers and employers to obtain information regarding new claims for electronic filing with the Ohio BWC.
3. Follow up with injured workers and employers for treatment and return to work information.
4. Document all phone calls, emails and faxes sent to injured workers, employers and/or providers in computer system.
5. Assist Intake Department in contacting the provider for initial medical.
6. Accept and approve indexed medical documents.
7. Communicate with the Case Management Supervisor regarding claims that meet the case management referral criteria and make referrals accordingly.
8. Prepare new claims or updates to existing claims for electronic filing by accurately entering information in the computer system.
9. Respond to customer inquiries regarding claim issues.
10. Assist SMAI with maintaining a high level of customer satisfaction.
11. Incorporate staff development training and changes in SMAI policies and procedures into the claim analyst activities.
12. Other duties as assigned.
Knowledge, Skills & Abilities Required:
- High School diploma or equivalent
- General knowledge of the insurance industry, with workers' compensation exposure preferred.
- Additional skills include, but are not limited to, effective written and verbal communication, accurate data entry, problem-solving skills, strong organizational ability and attention to detail.
- Basic computer literacy skills preferred
Salary : $18 - $20