Claims Examiner, Sr. jobs in Toledo, 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
  • Toledo, 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.
  • Just Posted

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Claims Examiner Specialist - Paramount
  • ProMedica
  • Toledo, OH FULL_TIME
  • Paramount Health Care, a ProMedica Health Plan, offers insurance products across six Midwest states. This Ohio-based company, headquartered in Toledo, has more than 685 employees dedicated to serving ...
  • 1 Month Ago

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Crew
  • MOORE, LARRY SR & JR
  • Waterville, OH FULL_TIME
  • Crew Person - You don’t want to work just anyplace, and you don’t want to work just anytime. Maybe it’s breakfast. Maybe it’s lunch. Maybe it’s late nights. Maybe it’s weekends. Whatever it is, you wa...
  • 23 Days Ago

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Maintenance Person
  • MOORE, LARRY SR & JR
  • Waterville, OH FULL_TIME
  • Maintenance Person - McDonald’s® company-owned and independent Owner-Operator restaurants are staffed by great people, and right now we’re looking for more of them. People with lots to offer. People l...
  • 23 Days Ago

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Maintenance Person
  • MOORE, LARRY SR & JR
  • Swanton, OH FULL_TIME
  • Maintenance Person - McDonald’s® company-owned and independent Owner-Operator restaurants are staffed by great people, and right now we’re looking for more of them. People with lots to offer. People l...
  • Just Posted

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Maintenance Person
  • MOORE, LARRY SR & JR
  • Maumee, OH FULL_TIME
  • Maintenance Person - McDonald’s® company-owned and independent Owner-Operator restaurants are staffed by great people, and right now we’re looking for more of them. People with lots to offer. People l...
  • Just Posted

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

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Central Supply Coordinator
  • Advanced Healthcare Center
  • Toledo, OH
  • Advanced Healthcare Center - Advanced Healthcare Center is currently recruiting for a Central Supply Coordinator to join...
  • 3/28/2024 12:00:00 AM

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Warehouse Agent ***Up to $1500 Sign on Bonus***
  • PINNACLE LOGISTICS
  • Swanton, OH
  • Description We are looking for Warehouse Cargo & Ramp Service Agents with enthusiastic attitudes for our new operation. ...
  • 3/28/2024 12:00:00 AM

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Structural Engineer
  • Robson Forensic
  • Toledo, OH
  • Job Description Job Description Structural Engineer Do you want to use your training, education, and experience in a new...
  • 3/27/2024 12:00:00 AM

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Claims Field Adjuster - Toledo Remote
  • Munich Re
  • Toledo, OH
  • **Claims Field Adjuster - Toledo Remote** ** WE OFFER** If you're looking for a rewarding career at a growing company wi...
  • 3/26/2024 12:00:00 AM

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Customer Service Representative
  • PFS - Professional Financial Services
  • Toledo, OH
  • Job Summary: Under moderate supervision, supports the manager in the daily operations of the branch office. Performs bra...
  • 3/25/2024 12:00:00 AM

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Internal Revenue Agent (Fed State Local Gvmt Spec - Examiner) 12 MONTH ROSTER AMENDED
  • Department Of The Treasury
  • Toledo, OH
  • Duties WHAT IS THE TAX EXEMPT & GOVERNMENT ENTITIES (TE/GE) DIVISION? A description of the business units can be found a...
  • 3/25/2024 12:00:00 AM

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Warranty Manager, Power Technologies
  • Dana Incorporated
  • Maumee, OH
  • Dana is a global leader in the supply of highly engineered driveline, sealing, and thermal-management technologies that ...
  • 3/24/2024 12:00:00 AM

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

Toledo (/təˈliːdoʊ/) is a city in and the county seat of Lucas County, Ohio, United States. Toledo is in northwest Ohio, at the western end of Lake Erie bordering the state of Michigan. The city was founded in 1833 on the west bank of the Maumee River, and originally incorporated as part of Monroe County, Michigan Territory. It was re-founded in 1837, after conclusion of the Toledo War, when it was incorporated in Ohio. After the 1845 completion of the Miami and Erie Canal, Toledo grew quickly; it also benefited from its position on the railway line between New York City and Chicago. The first...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Claims Examiner, Sr. jobs
$60,022 to $77,384
Toledo, 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