Medical Claims Examiner (Workers Comp)

Group 1001 is a consumer-centric, technology-driven family of insurance companies on a mission to deliver outstanding value and operational performance by combining financial strength and stability with deep insurance expertise and a can-do culture. Group1001's culture emphasizes the importance of collaboration, communication, core business focus, risk management, and striving for outcomes. This goal extends to how we hire and onboard our most valuable assets - our employees.
Company Overview:
Clear Spring Property and Casualty is a leading provider of property and casualty insurance. Our future-forward strategy is rooted in deep industry knowledge and a mastery of emerging technologies. Clear Spring Property and Casualty Company is a subsidiary of Delaware Life Insurance Company and its parent company, Group1001. Our relationship with these organizations has yielded an innovative technology platform that provides smarter risk management solutions for property and casualty insurance brokers. Clear Spring is dedicated to Group1001's mission: making insurance more useful, intuitive and accessible for everyone. We're confident in our forward-thinking products, and that you'll love working with us.
Group 1001, and its affiliated companies, is strongly committed to providing a supportive work environment where employee differences are valued. Diversity is an essential ingredient in making Group 1001 a welcoming place to work and is fundamental in building a high-performance team. Diversity embodies all the differences that make us unique individuals. All employees share the responsibility for maintaining a workplace culture of dignity, respect, understanding and appreciation of individual and group differences.
The Medical Claims Examiner:
The Medical Claims Examiner will be responsible for working in combination with the Claims Consultant to provide claims service to policyholders. This position is responsible for servicing accounts, which will include corresponding with insureds regarding claims topics. This role is responsible for securing medical documentation, processing and assisting the Claims Consultant's workflow. Also works in conjunction with the Claims Consultant making decisions concerning strategies for minimizing overall exposure of claims.
Duties and responsibilities:

• Provide exceptional customer service consistent with the philosophy of Lackawanna Insurance Group.
• Review incoming bills and treatment notes for causality.
• Process daily mail and payments.
• Maintain contact with claimant, insured, and medical provider on medical only files.
• Identify files that need to be transferred to the Claims Consultant when change in status to a "Lost Time" file is apparent. Make transfer in a timely manner.
• Complete any Bureau or other legal documents as appropriate.
• Request reserves and provide reasoning for increase on files when necessary.
• Work in tandem with Claims Consultant to provide claims knowledge to policyholders.
• Assist in providing phone coverage on a rotating basis.
• Communicate verbally and in writing with stakeholders in an effective and professional manner.
• Ensure data submitted is accurate, timely, and in compliance with all requirements.
• Monitor and complete transactions in a timely and accurate method in required computer programs.
• Other duties as assigned that contribute to the overall productivity and well-being of the company, specifically to the Claims Department.
• Support workflow from remote employees, if applicable. The methods may vary based on work location of assigned Claims Consultants.

Experience requirements:

• Minimum of one-year experience in the insurance industry preferred.
• Medical terminology experience preferred.
• Strong time-management, communication, and PC skills.
• Proficiency in Microsoft Office required.
• Proven ability to build strong working relationships.

Compensation:
Our compensation reflects the cost of labor across several U.S. geographic markets. The base pay for this position ranges from $34,300/year in our lowest geographic market up to $72,000 in our highest geographic market. Pay is based on a number of factors including market location and may vary depending on job-related knowledge, skills, and experience.
Benefits Highlights:
Employees (and their families) are eligible to participate in the Company's comprehensive health, dental, and vision insurance plan options. Employees are also eligible for Basic and Supplemental Life Insurance, Short and Long-Term Disability, and to enroll in the Company's Employee Assistance Program and other wellness initiatives. Employees may also participate in the Company's 401K plan, with matching contributions by the Company.