Medical Claims Specialist

Non-exempt; Full Time; Benefits Eligible

Overview 

Protecting our policyholders’ dreams, passions, and livelihoods has a direct impact on the communities we serve. We work towards excellence, conduct ourselves with high integrity, and take our work seriously, but not ourselves. Small Details. Big Difference. Find out how you can make a difference with a career at Society.

Society Insurance is seeking a Medical Claims Specialist. The purpose of this role is to provide a timely resolution of Workers Compensation Claims that do not have loss of time from work. 

About the Role

  • Initiates the claims process by setting accurate case reserves and completing data-entry.
  • Determines insurance coverage by interviewing claimants, insureds, and health care providers.
  • Determines insurance coverage by reviewing medical documentation and files.
  • Communicates decisions on claims to injured workers, insureds, health care providers, etc.
  • Authorizes payments on medical bills and fees, within statutory guidelines. 
  • Identifies files that will involve potential investigation or subrogation.
  • Ensures accurate file documentation by complying with company procedures.

About You 

  • You enjoy investigating and are naturally curious. 
  • You care about others and are concerned with their wellbeing. 
  • You are patient and are cool under pressure.  

What it Will Take

  • High School diploma or equivalent
  • 1+ year of customer service experience 
  • Demonstrated mathematical skills and general knowledge of office equipment

What Society Can Offer 

  • Comprehensive Benefits: Salary with Bonus Plan; Health, Dental, Vision, and Life Insurance
  • Retirement: Traditional or Roth 401K and Defined Contribution PLUS Profit-Sharing Plan
  • Work-Life Balance: PTO; Flexible Scheduling; Telecommuting Options; Company-Paid Holidays 
  • Education: Career Coaching; Company-Paid Courses; Student Loan & Tuition Reimbursement
  • Community: Paid Volunteer Time; Charitable Match; Team Sponsorships
  • Wellness: Health Club Membership; Wellness Reimbursement; Employee Assistance Program 

Society Insurance prohibits discrimination and harassment of any type against applicants and employees on the basis of race, color, religion, sex, national origin, age, handicap, disability, genetics, veteran status or military service, marital status or sexual orientation, gender identity or expression, or any other characteristic or status protected by federal, state or local laws. Society Insurance also provides reasonable accommodations to qualified individuals with disabilities in accordance with the requirements of the Americans with Disabilities Act and applicable state and local laws.

Society Insurance is a drug-free workplace.  Any candidate who receives an offer of employment from Society will be required to undergo a pre-employment drug test for controlled substances.  All offers of employment are contingent upon successful completion of the pre-employment drug test, which is conducted in accordance with Society’s substance abuse policy.

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