Medical Only Claims Trainee

<strong>AF Group (Lansing, Mich.) and its subsidiaries are a premier provider of innovative insurance solutions. Insurance policies may be issued by any of the following companies within AF Group: Accident Fund Insurance Company of America, Accident Fund National Insurance Company, Accident Fund General Insurance Company, United Wisconsin Insurance Company, Third Coast Insurance Company, or CompWest Insurance Company.</strong>

Lansing, USA

AF Group

<p class="p1"><strong>AF Group&rsquo;s focused and passionate team uses industry-leading best practices, analytics and resources to manage risk and minimize loss for our policyholders while strengthening businesses with our valued independent agent partners.</strong></p> <p class="p1"><strong>We strive to continuously increase the long-term value of our organization by outperforming our industry peers and fostering a culture of underwriting and claims excellence.</strong></p> https://www.afgroup.com/

keywords: position summary,position details,claims,assist,reporting,administration,education,experience,knowledge,skills

Non-Manager

Competitive Compensation and Benefits Package

Overview: <p><span style="font-style: inherit; font-weight: inherit;">This is an entry-level position. This position leads to a Medical Only Claims Specialist I and is expected to last up to 12 months. Upon completion of the training plan the incumbent is expected to be </span><span style="font-style: inherit; font-weight: inherit;">proficient with the</span><span style="font-style: inherit; font-weight: inherit;"> Medical Only Claims policies, processes, procedures, and terminology related to the job. In addition, the incumbent will be proficient in the job responsibilities and tasks of the Medical Only Claims Specialist I position description. The incumbent will be evaluated on their progress and successful completion of the training plan each quarter. Upon satisfactory completion, the incumbent will be eligible for the Medical Only Claims Specialist I position.&nbsp; Medical Only Claims Associate will work with all members of the team and may receive direction, support, and instruction from the Manager or Medical Only Claims Specialists depending on the assignment.&nbsp;</span></p>
Responsibilities: <ul> <li><span style="font-style: inherit; font-weight: inherit;">Assist Medical Only Claims Specialist with the investigation and management of workers compensation claims.&nbsp;</span></li> <li><span style="font-style: inherit; font-weight: inherit;">Assists with determining and managing the on-going medical treatment program including directing care, creating panels, and approving provider requests.&nbsp;</span></li> <li><span style="font-style: inherit; font-weight: inherit;">Evaluates medical reports and correspondence for appropriate action/documentation.&nbsp;</span></li> <li><span style="font-style: inherit; font-weight: inherit;">Supports the customer service work and processes for the multi-functional claims team; Communicates and collaborates with team members to ensure the appropriate and timely handling of claims in other states.&nbsp;</span></li> <li><span style="font-style: inherit; font-weight: inherit;">May be required to act as a back up to the MOCS. For items such as Verifies workers&rsquo; compensation coverage of employers and injured employees.&nbsp;</span></li> <li><span style="font-style: inherit; font-weight: inherit;">Documents specifics of claims with potential for subrogation.&nbsp;&nbsp;</span></li> <li><span style="font-style: inherit; font-weight: inherit;">Approves payment based on knowledge of the treatment plan and medical support showing relationship of treatment to the injury.&nbsp;</span></li> <li><span style="font-style: inherit; font-weight: inherit;">Concludes and closes files following resolution of claims to meet internal performance standards while complying with state legislation to avoid penalties and manage expenses.&nbsp;</span></li> <li><span style="font-style: inherit; font-weight: inherit;">Coordinates with outside vendors to ensure cost containment efforts.&nbsp;&nbsp;</span></li> <li><span style="font-style: inherit; font-weight: inherit;">Establishes and maintains effective working relationships with all internal and external customers. Assists with determining appropriate response to regulatory inquiries.&nbsp;</span></li> <li><span style="font-style: inherit; font-weight: inherit;">Composes correspondence and various reports in the administration of workers compensation claims; sets appropriate diaries.&nbsp;&nbsp;</span></li> <li><span style="font-style: inherit; font-weight: inherit;">Reads, routes and keys incoming mail, runs reports and answers/responds to incoming phone calls on both direct and ACD line, faxes and emails. This may include completing work for peers during absences to provide uninterrupted service to customers.&nbsp;</span></li> <li><span style="font-style: inherit; font-weight: inherit;">Demonstrate growth of skills working towards the more complex responsibilities of the Medical Only Claims Specialist I position.&nbsp;</span></li> <li><span style="font-style: inherit; font-weight: inherit;">Increase knowledge of how Accident Fund Insurance Company of America runs and how Workers Compensation Insurance works.&nbsp;</span></li> </ul>
Requirements: <span style="font-style: inherit; font-weight: inherit;"><strong><strong style="font-style: inherit;">EDUCATION AND EXPERIENCE&nbsp;&nbsp;</strong></strong>&nbsp;</span><br /><span style="font-style: inherit; font-weight: inherit;"><em><em style="font-weight: inherit;">Relevant combination of education and experience may be considered in lieu of degree</em></em>&nbsp;</span><br /><span style="font-style: inherit; font-weight: inherit;">High school diploma&nbsp;</span><br /><span style="font-style: inherit; font-weight: inherit;">2 years insurance experience (Could add finance, medical, or any other applicable experience)&nbsp;</span><br /><span style="font-style: inherit; font-weight: inherit;">&nbsp;</span><br /><span style="font-style: inherit; font-weight: inherit;">OR&nbsp;</span><br /><span style="font-style: inherit; font-weight: inherit;">&nbsp;</span><br /><span style="font-style: inherit; font-weight: inherit;">Associates degree in insurance, business administration, health administration and/or related field. Combination of education and experience may be considered in lieu of a degree.&nbsp;</span><br /><span style="font-style: inherit; font-weight: inherit;">&nbsp;</span><br /><span style="font-style: inherit; font-weight: inherit;">&nbsp;</span><br /><span style="font-style: inherit; font-weight: inherit;"><strong><strong style="font-style: inherit;">OTHER SKILLS AND ABILITIES</strong></strong>&nbsp;</span><br /> <ul> <li><span style="font-style: inherit; font-weight: inherit;">General knowledge of insurance operations.&nbsp;</span></li> <li><span style="font-style: inherit; font-weight: inherit;">Ability to work effectively in a multifunctional business unit.&nbsp;</span></li> <li><span style="font-style: inherit; font-weight: inherit;">Excellent verbal and written communication skills.&nbsp;</span></li> <li><span style="font-style: inherit; font-weight: inherit;">Ability to use diplomacy, discretion, and appropriate judgment when responding to inquiries from staff and external customers as well as anticipating needs of the department.&nbsp;</span></li> <li><span style="font-style: inherit; font-weight: inherit;">Ability to effectively exchange information clearly and concisely, and present ideas, report facts and other information and respond to questions as appropriate.&nbsp;</span></li> <li><span style="font-style: inherit; font-weight: inherit;">Ability to negotiate, build consensus, and resolve conflict.&nbsp;</span></li> <li><span style="font-style: inherit; font-weight: inherit;">Excellent organizational skills and ability to prioritize work.&nbsp;</span></li> <li><span style="font-style: inherit; font-weight: inherit;">Ability to manage multiple priorities and meet established deadlines.&nbsp;</span></li> <li><span style="font-style: inherit; font-weight: inherit;">Ability to perform mathematical calculations.&nbsp;</span></li> <li><span style="font-style: inherit; font-weight: inherit;">Excellent analytical and problem solving skills.&nbsp;</span></li> <li><span style="font-style: inherit; font-weight: inherit;">Ability to use reference manuals.&nbsp;</span></li> <li><span style="font-style: inherit; font-weight: inherit;">Basic knowledge of medical terminology.&nbsp;</span></li> <li><span style="font-style: inherit; font-weight: inherit;">Ability to comprehend various issues, address them or refer them for appropriate decision-making.&nbsp;</span></li> <li><span style="font-style: inherit; font-weight: inherit;">Ability to work with minimal direction.&nbsp;</span></li> <li><span style="font-style: inherit; font-weight: inherit;">Ability to proofread documents for accuracy of spelling, grammar, punctuation, and format.&nbsp;</span></li> </ul> <br /><span style="font-style: inherit; font-weight: inherit;">&nbsp;</span><br /><span style="font-style: inherit; font-weight: inherit;"><strong><strong style="font-style: inherit;">ADDITIONAL EDUCATION, EXPERIENCE, SKILLS, KNOWLEDGE AND/OR ABILITIES PREFERRED:</strong></strong><em><em style="font-weight: inherit;">&nbsp;</em></em></span><br /><span style="font-style: inherit; font-weight: inherit;">Associates degree preferred&nbsp;</span><br /><span style="font-style: inherit; font-weight: inherit;">Progress towards or completion of Insurance Institute of America (IIA) or other insurance related designation(s) preferred&nbsp;</span><br /> <p><span style="font-style: inherit; font-weight: inherit;">&nbsp;</span></p>