Medical Claims Coordinator

Medical Claims Coordinator

Job Category: Worker's Compensation

Full-Time

Remote

Salary: $62,500 USD per year

Location: Omaha, NE, USA

Description

Your Mission: Champion Quality Medical Care

As a bilingual Workers Compensation Medical Claims Coordinator, you'll play a pivotal role in supporting our valued workforce of Industrial Athletes (IAs) across more than 150 client locations in the U.S. and Canada. Your mission is to manage the medical treatment process proactively, providing excellent clinical judgement, ensuring our employees receive compassionate, high-quality care that facilitates their rapid and safe return to work, while effectively controlling costs and ensuring compliance. You will be part of a small, dedicated team responsible for answering our Injury Reporting Hotline, and directing every stage of an injured workers care and recovery, whether it's ordering tests, managing transportation, translating, reviewing records, or handling insurance pre-authorizations, denials and appeals.

If you're passionate about healthcare advocacy, thrive in fast-paced environments, and have the experience to navigate complex medical and insurance landscapes, this role offers an exciting opportunity to positively impact employees' lives and organizational outcomes.

Every third week, you will serve as the primary representative for our Injury Reporting Hotline, providing 24-hour on-call support.

Your Impact: Ensure Optimal Outcomes for Injured Employees

Medical Coordination & Case Management

• Serve as a primary point of contact and medical expert, authorizing initial care for injured Industrial Athletes (IAs) and directing them to preferred providers.
• Monitor and manage ongoing medical treatment, ensuring timely and appropriate care, tracking recovery progress, and ensuring compliance with treatment plans.
• Actively review provider treatment plans, escalating concerns regarding excessive or inappropriate care, self-referrals, or treatment deviations from standard care guidelines.

Provider Relationship Management

• Build and maintain strong, positive relationships with medical providers, ensuring quality care, effective cost management, and adherence to preferred provider standards.
• Educate providers on Eclipse's medical management protocols, emphasizing timely recovery, appropriate return-to-work strategies, and prevention of excessive ancillary treatments.
• Evaluate provider effectiveness, reporting outcomes to management, and recommending provider adjustments as needed.

Strategic Collaboration & Compliance

• Work closely with internal stakeholders, insurance carriers, claims adjusters, and field personnel, ensuring aligned processes and clear communication regarding medical treatment plans.
• Collaborate effectively with insurance carriers and claims adjusters, identifying and addressing cases of excessive or unnecessary treatments.
• Maintain thorough documentation, tracking patient care progress, appointments, provider interactions, and outcomes to support compliance and audits.

Communication & Advocacy

• Act as a trusted liaison among injured employees, medical providers, insurance carriers, and internal Eclipse teams, advocating for fair treatment and efficient resolution of cases.
• Provide clear, compassionate, and confidential communication to injured employees, ensuring they understand treatment options, recovery expectations, and their benefits.

Position Requirements:

• Bilingual, in Spanish & English (or French & English) preferred
• LPN (Licensed Practical Nurse) or EMT background required; RN licensure preferred.
• 2-5 years of clinical, hospital, pre-hospital, or related healthcare experience.
• Experience and knowledge of HIPPA compliance.
• Relevant professional experience.
• Demonstrated expertise in Workers' Compensation processes, including familiarity with relevant medical and insurance terminology, claims handling, and regulatory compliance.
• Strong ability to analyze medical situations, implement effective care strategies, and advocate for appropriate treatment courses.
• Proficient in Microsoft Office Suite (Excel, Outlook, Word) and able to quickly learn industry-specific software.
• Exceptional written and verbal communication skills, with the ability to clearly articulate medical and workers' compensation concepts to diverse stakeholders.
• Ability to multitask and perform effectively under pressure, managing rapidly changing priorities and deadlines.
• Flexibility with scheduling, willing to support evening or weekend on-call triage responsibilities.

Who You Are: A Compassionate, Detail-Oriented Medical Leader

You thrive in environments requiring a combination of compassion, medical expertise, and strategic problem-solving. You are detail-oriented, maintain confidentiality, and demonstrate a positive attitude towards change. You're capable of independent action yet understand the importance of contributing to team success.

Equal Opportunity Employer| Drug Free Workplace| Must be able to work in the US