Claims Examiner, Sr. jobs in Columbus, OH

Claims Examiner, Sr. reviews, evaluates, and processes insurance claims and makes recommendations for resolution. Examines and authorizes insurance claims investigated by insurance adjusters. Being a Claims Examiner, Sr. studies reports prepared by adjusters and similar claims to determine the extent of insurance coverage and validity of the claim. Communicates with agents, claimants, and policy holders. Additionally, Claims Examiner, Sr. determines settlement according to organization practices and procedures. May require a bachelor's degree. Typically reports to a supervisor or manager. The Claims Examiner, Sr. occasionally directed in several aspects of the work. Gaining exposure to some of the complex tasks within the job function. To be a Claims Examiner, Sr. typically requires 2 -4 years of related experience. (Copyright 2024 Salary.com)

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Claims Examiner
  • Sheakley Group, Inc
  • Columbus, OH FULL_TIME
  • Summary: Non-case management staff responsible for supporting the case management process. Always works under direct supervision of a Nurse Case Manager and does not make clinical judgment.

    We offer employees a range of perks including but not limited to:

    • Competitive Pay
    • Health, dental, vision, and life insurance
    • Additional insurance options: Critical Illness, Long Term, Short Term Disability, Accidental Death and Dismemberment, Employee Assistance Program, Legal Shield
    • 401(k) savings plan with match after 1 year
    • Continuous professional training and development
    • 8 Paid Holidays
    • Paid Vacation and PTO available
    • A paid day off for your birthday and work anniversary
    • Employee focused culture with appreciation events all year

    Primary Responsibilities:

    • Establish a three-point contact between the injured worker, employer and provide to gather information needed to file a claim with the Ohio BWC
    • Communication and collaboration with injured workers (IW), employers, providers, third party administrators (TPA), attorneys, and the BWC to obtain a safe return to work (RTW) while working within BWC designated guidelines.
    • Effectively apply the MCO process including completion of appropriate first report of injury documentation, medical management templates, documentation of potential barriers to a successful RTW within the scope of the non-clinical position.
    • Process all Treatment Requests (C-9s) within 72 hours to provide the IW with the treatment medically necessary and appropriate for the Allowed Conditions. Staff C-9 requests with the Nurse Case Manager, or Medical Director as needed.
    • Follow up with providers to obtain current treatment plans, results of diagnostics and RTW goals. Obtain modified duty availability from employers and communicate to providers and IWs. Obtain restrictions to a full RTW from provider and communicate to the employer and IW.
    • Properly refer all cases to the Nurse Case Manager when appropriate as well as utilize the RN for all clinical issues pertaining to the IW's claims. Identify IWs who are potential vocational rehabilitation candidates and complete the referral process.
    • Adherence to all Health Management Solutions (HMS) policies and URAC standards as well as all Confidentiality policies and guidelines. Ensure that all documentation is current, accurate and complete including remaining current with all diaries. Follow all HMS and BWC guidelines for appropriate medical management of claims and participate in educational and informational seminars as needed.
    • Completion of team peer-to-peer FROI/CE audits, quarterly.
    • Other duties as assigned.

    Qualifications:

    • High School Diploma/GED
    • 2 years of MCO experience preferred
    • Exceptional written, telephonic, and oral communication (public speaking), leadership, problem-solving, interpersonal, and organizational skills required. Ability to coordinate and organize multiple priorities.
    • Excellent knowledge of medical terminology
    • Experience using Microsoft Office programs, especially Excel, Word, PowerPoint, and Access.
  • 1 Day Ago

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Claims examiner
  • UST
  • Columbus, OH FULL_TIME
  • Claims Examiner UST HealthProof is looking for Claims Examiner, reporting to the Claims Team Leader, the Examiner is responsible for adjudication of healthcare claims utilizing employer and payer spec...
  • 8 Days Ago

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Claims Examiner Assistant
  • Universal Fire & Casualty Insurance Company
  • Dublin, OH FULL_TIME
  • Claims Examiner AssistantUniversal Shield Insurance Group (and its member companies – Universal Fire & Casualty Insurance Company (www.ufcic.com) and Shield Indemnity, Inc. (www.shieldindemnity.com) h...
  • 15 Days Ago

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Claims Assistant
  • Sedgwick Claims Management Services Inc.
  • Dublin, OH FULL_TIME
  • Taking care of people is at the heart of everything we do, and we start by taking care of you, our valued colleague. A career at Sedgwick means experiencing our culture of caring. It means having flex...
  • 5 Days Ago

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Help Desk Analyst 3 - (100% Onsite)
  • SR International Inc.
  • Columbus, OH FULL_TIME
  • Job DetailsRole: - Help Desk Analyst 3 - 731903 (100% Onsite)Contract: Until 06/30/2024 (with possible extension)Location: Rhodes State Office Tower, 30 E Broad St 14th Floor, Columbus, OH 43215 Descr...
  • 7 Days Ago

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Service Center Representatives
  • Sedgwick Claims Management Services Inc.
  • Dublin, OH OTHER
  • The 'Apply with SEEK' option will be utilized for International applicants, mainly Australia. If this does not apply to you please use the 'Apply' option. Service Center Representatives IF YOU CARE, T...
  • 10 Days Ago

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0 Claims Examiner, Sr. jobs found in Columbus, OH area

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Commercial Insurance Advisor
  • Bickle Insurance Services, LLC
  • Columbus, OH
  • Bickle Insurance is looking for a highly motivated & self-driven Commercial Insurance Advisor. This position is a sales-...
  • 3/28/2024 12:00:00 AM

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External Auditor 1 (PN 20036354)
  • State of Ohio
  • Columbus, OH
  • Join Our Team! Accepting applications for External Auditor 1 Who Are We? The Department of Developmental Disabilities (D...
  • 3/28/2024 12:00:00 AM

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Office Clerk-CCH1
  • United Church Homes
  • Westerville, OH
  • Community Name: Columbus Colony Housing 1 The Office Coordinator works directly with the Housing Manager and is responsi...
  • 3/28/2024 12:00:00 AM

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Corporate Counsel, Labor and Employment
  • Jobs for Humanity
  • Columbus, OH
  • Company Description Jobs for Humanity is partnering with Safelite to build an inclusive and just employment ecosystem. T...
  • 3/28/2024 12:00:00 AM

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Catastrophe Property Adjuster *MULTIPLE REMOTE LOCATIONS*
  • Erie Insurance
  • Columbus, OH
  • Division or Field Office: Claims Division Department of Position: Catastrophe Operations Dept Work from: Home, in ERIE O...
  • 3/27/2024 12:00:00 AM

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Remote Claims Auditor II
  • National General Insurance
  • Columbus, OH
  • Job Description National General Insurance is recruiting for a Remote Claims Auditor . The ideal candidate should have a...
  • 3/25/2024 12:00:00 AM

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WC claims associate
  • Sedgwick
  • Dublin, OH
  • Taking care of people is at the heart of everything we do, and we start by taking care of you, our valued colleague. A c...
  • 3/25/2024 12:00:00 AM

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Private Investigator
  • Allied Universal® Compliance and Investigations
  • Columbus, OH
  • Overview Allied Universal® Compliance and Investigations, North America's leading expert insurance claim investigations,...
  • 3/15/2024 12:00:00 AM

The confluence of the Scioto and Olentangy rivers occurs just north-west of Downtown Columbus. Several smaller tributaries course through the Columbus metropolitan area, including Alum Creek, Big Walnut Creek, and Darby Creek. Columbus is considered to have relatively flat topography thanks to a large glacier that covered most of Ohio during the Wisconsin Ice Age. However, there are sizable differences in elevation through the area, with the high point of Franklin County being 1,132 ft (345 m) above sea level near New Albany, and the low point being 670 ft (200 m) where the Scioto River leaves...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Claims Examiner, Sr. jobs
$60,989 to $78,631
Columbus, Ohio area prices
were up 1.3% from a year ago

Claims Examiner, Sr. in Riverside, CA
Health Claims Examiners, or Health Information Technicians, enter data electronically to process transactions.
December 14, 2019
Claims Examiner, Sr. in Evansville, IN
If you’re in dire straits, we can advise you on steps to get the OWCP claims examiner to pay attention to your needs, such as contacting the Department of Labor’s district director, or the national director via mail.
February 12, 2020
Claims Examiner, Sr. in Springfield, IL
No, the examiner is only involved in performing the exam and providing the results to the claims processor.
January 13, 2020