Icon hamburger
What job do you want?
Apply to this job.
Think you're the perfect candidate?
Apply on company site

You’re being taken to an external site to apply.

Enter your email below to receive job recommendations for similar positions.

Medical Only Claims Specialist I

Accident Fund Holdings, Inc Lansing Full-Time
Apply on company site


This is an entry level Medical-Only Claims (MOCSI) position that is part of a MOCS training program which is expected to last approximately one year.

Primarily responsible for the investigation and management of workers' compensation claims. Conducts a 1 to 3 point contact to triage claims, which is dependent on either the facts of the case or the claim type, and assists in the return-to-work process. This includes calling and discussing potential claim activity and work-related injuries with policyholders, claimants, providers, attorneys, agents, and state agencies. Provides backup support to other Claim Handlers.

Primary Responsibilities:

  • Assists with investigation of workers' compensation claims with a mandatory contact to the employer within the required time frame, and with additional contacts to the employee or provider as necessary.
  • Assists with determining and managing the on-going medical treatment program including directing care, creating panels and approving provider requests.
  • Remains abreast of new case law decisions affecting claim and medical management.
  • Monitors the work status of the claimants.
  • Evaluates medical reports and correspondence for appropriate action/documentation.
  • Supports the customer service work and processes for the multi-functional claims team; Communicates and collaborates with team members to ensure the appropriate and timely handling of claims in other states.
  • May be required to act as a back up to the MOCS. For items such as Verifies workers' compensation coverage of employers and injured employees.
  • Determines causal relationship between the reported injury and the incident to ensure appropriate payment of benefits.
  • Documents specifics of claims with potential for subrogation.
  • Manages medical bills for non-idemnity and indemnity claims directly associated with the claimed injury. Approves payment based on knowledge of the treatment plan and medical support showing relationship of treatment to the injury.
  • Concludes and closes files following resolution of claims to meet internal performance standards while complying with state legislation to avoid penalties and manage expenses.
  • Coordinates with outside vendors to ensure cost containment efforts.
  • Establishes and maintains effective working relationships with all internal and external customers.Assists with determining appropriate response to regulatory inquiries.
  • Composes correspondence and various reports in the administration of workers compensation claims; sets appropriate diaries.cts employee-employer interviews to assist in the return-to-work proceReads, routes and keys incoming mail, runs reports and answers/responds to incoming phone calls, faxes and emails.

Recommended skills

Workers' Compensation
Apply to this job.
Think you're the perfect candidate?
Apply on company site

Help us improve CareerBuilder by providing feedback about this job: Report this job

Report this Job

Once a job has been reported, we will investigate it further. If you require a response, submit your question or concern to our Trust and Site Security Team

Job ID: 19-1903


For your privacy and protection, when applying to a job online, never give your social security number to a prospective employer, provide credit card or bank account information, or perform any sort of monetary transaction. Learn more.

By applying to a job using CareerBuilder you are agreeing to comply with and be subject to the CareerBuilder Terms and Conditions for use of our website. To use our website, you must agree with the Terms and Conditions and both meet and comply with their provisions.