Claims Specialist

Company: Joerns Healthcare, LLC ( Learn More )

General Information
High School
At least 2 year(s)
Not Specified
Job Description

Joerns Healthcare is a leading national distributor of therapeutic support surfaces, bariatric care equipment, negative pressure wound therapy systems, and safe patient handling solutions. We serve special patient handling needs across the entire continuum of care, including acute care hospitals, long term acute care hospitals, skilled nursing facilities, rehabilitation facilities, and hospice centers.

We continually strive to provide the most exceptional service, the most affordable products, and the most innovative patient care solutions to our customers. We are currently searching for skilled, self-motivated and dedicated professionals to add to our team. We offer hands on training, benefits and an outstanding work environment.


At Joerns Healthcare, each eligible employee receives a competitive total compensation package including Medical, Dental, Vision, Life Insurance and Short Term Disability. Our employees also receive Paid Vacation and Holidays. Please note that benefits may vary by site.

Position Summary

The Claims Specialist is the claims expert and primary point of contact for the company’s field operations, worker compensation and auto insurance carriers and third party administrators.  A claims analyst monitors liability claims from start to finish, verifying and updating information on submitted claims, reviewing the policy to determine which charges are eligible for reimbursement, reconciling a claims adjuster's estimates, negotiating payment to all parties and following up to ensure that payments are made.  The Claims Specialist will coordinate and oversee all Joerns’ claim matters, serve as an “on-call” expert for the investigation of serious incidents and accidents, and provide financial and process guidance on all claims matters.

Major Duties & Responsibilities
  • Provide timely and effective claim service; handle administration of Federal Medical Leave Act (FMLA), Leave of Absence (LOA), Workers compensation and Auto claims.
  • Identifies action plan; determine benefits due; make timely case decisions based on service expectations.
  • Communicates decisions and on-going expectations with claimants and third party vendors.
  • Communicates with the injured employee’s supervisor.  Receives incident information and determines if there are red flags relative to the incident, claim, or the employee.
  • Document business requirements to ensure systems and processes are setup correctly.
  • Develop and implement service level agreements with each carrier/vendor.
  • Assist with developing and reporting performance metrics to analyze performance.
  • Run reports and provides claim status reports on a regular basis.
  • Oversee data gathering and research on complex assignments and projects.
  • Assures appropriate tracking of eligible time period toward FMLA/LOA offering.
  • Regularly communicates and interacts with providers and specialists to clarify or authenticate medical information when applicable.
  • Coordinates FMLA/LOA Administration with Short-Term Disability (STD) and Workers Compensation (WC) Administration.
  • Generates timely determination of FMLA/LOA eligibility within required timeframe. 
  • Analyzes FMLA claims to determine eligibility and certification in compliance with state and federal regulations.
  • Maintains communication with the injured employee, team leader throughout the life of an incident.
  • Documents all communications/information related to an incident or injury claim (incident information, investigation, medical treatment, and associate conversations, etc.), communicates all information and status with the third party claims administrator, and manage all claims to closure.
  • Required Education

    Associate’s degree or high school diploma with experience in specialized field may be acceptable

    Required Skills & Experience
  • Minimum 2 years’ experience in healthcare administration, analytics, and/or insurance
  • Exceptional customer service skills.
  • Knowledge of state and federal FMLA regulations.
  • Knowledge of medical disability management.
  • Critical thinking skills and decision making ability. 
  • Time management skills and ability to multi-task are key components.
  • Proficiency with MS Office applications.
  • Ability to perform effectively in a team environment.
  • Previous Claim experience or Leave of Absence administration preferred but not required.
  • Excellent oral and written communication, including presentation skills.
  • Analytical and interpretive skills.
  • Strong organizational skills.
  • Excellent interpersonal skills.
  • Ability to meet or exceed Performance Competencies.
  • Preferred Skills, Experience & Education
  • Bachelor’s degree with business experience preferred
  • Joerns Healthcare is an Equal Opportunity Employer


    Job Requirements