Job Overview
We are seeking a dynamic and detail-oriented Insurance Case Manager to join our agency team. In this vital role, you will oversee the management of insurance claims, ensuring accurate processing, compliance with regulations, and effective communication with clients, healthcare providers, and insurance carriers. Your expertise will help streamline claims adjudication, facilitate negotiations, and ensure timely resolution of cases. This position offers an exciting opportunity to contribute to a fast-paced environment where organizational skills and insurance knowledge drive success. The ideal candidate is proactive, customer-focused, and possesses a comprehensive understanding of various insurance lines including workers' compensation and health insurance.
Responsibilities
- Manage the entire lifecycle of insurance claims, from initial filing through resolution, ensuring accuracy and compliance with regulatory standards.
- Interpret insurance policies to determine coverage eligibility and identify appropriate claim procedures.
- Utilize insurance claims management software to document case details, track progress, and generate reports efficiently.
- Process medical claims by reviewing medical documentation, coding diagnoses using ICD-9, ICD-10, CPT, HCPCS codes, and verifying medical billing accuracy.
- Negotiate settlements with healthcare providers and claimants to reach fair resolutions while maintaining regulatory compliance.
- Conduct thorough data entry and maintain organized filing systems for all claim-related documents including medical records and correspondence.
- Collaborate with medical professionals to interpret complex medical terminology and ensure proper claims adjudication.
- Stay informed on insurance regulation changes and ensure all claims processing adheres to current laws and policies.
- Handle inquiries from clients regarding claim status, policy coverage, or documentation requirements with professionalism and clarity.
- Support the team with clerical tasks such as filing, record keeping, and updating databases using Microsoft Office tools like Word and Excel.
Experience
- Proven experience in insurance claims management within commercial insurance or workers' compensation sectors.
- Strong knowledge of medical claims processing, coding (ICD-9/10, CPT, HCPCS), and medical documentation review.
- Familiarity with insurance regulation standards and regulatory compliance in claims processing.
- Experience using insurance claims management software and financial software for data entry and reporting purposes.
- Excellent organizational skills with the ability to handle multiple cases simultaneously while maintaining attention to detail.
- Customer service experience demonstrating effective communication skills in resolving client inquiries or disputes.
- Clerical experience involving filing systems, data entry, typing accuracy, and handling sensitive information securely.
- Knowledge of workers’ compensation law and workers' compensation claims procedures is highly desirable.
Join us in delivering exceptional service by managing complex insurance cases efficiently! We value energetic professionals eager to make a positive impact through their expertise in claims management while fostering a compliant and customer-centric environment.
Pay: $27.91 - $33.61 per hour
Benefits:
Work Location: Remote
