Cities & Villages Mutual Insurance Company
Med-Only Claims Specialist
Wauwatosa, WI
Salary: $52,312 - $70,033
Under the general supervision of the Worker's Compensation Claims Manager, this position is responsible for investigating, processing, and adjusting med-only worker's compensation claims.
WHY JOIN THE CVMIC TEAM:
The ability to make a difference to internal and external customers!
Great variety in what you do each day in a fast-paced environment
Flexibility with your schedule
A supportive team environment
Outstanding benefits that include:
Company-paid retirement contribution into a SEP Plan (12.1% of salary, after one year of employment)
Company-paid health insurance monthly premiums
Tuition reimbursement for continuing education
View what employees say about working here!
Essential Duties & Responsibilities
Sets up new medical-only files for handling.
Investigates and processes payments on medical-only claims in an accurate and timely manner; investigates and processes payments.
Reviews first report of injury forms (WC-12) and follows up with claimant, insured, medical providers, or others in a timely manner to determine compensability.
Enters workers' compensation claims information into Origami (Claims System) in an accurate and timely manner.
Interviews, telephones, or corresponds with member representatives, member employees, supervisors, claimants, witnesses, and medical personnel; reviews medical and hospital records in a timely manner to determine compensability while maintaining required confidentiality.
Maintains and updates claim files with current diaries, file notes, and treatment plans in the claims system.
Reviews and pays medical bills; Submits medical bills for third-party review.
Researches and resolves medical bills billed to the claimant or sent to collection on the claimant's behalf.
Processes and releases payments for Incentive Program to claimants.
Monitors claims to identify and follow-up on subrogation opportunities.
Refers chiropractic claims to a chiropractor for review.
Handles or refers telephone, written, and e-mail inquiries from members and others.
Composes and edits routine correspondence.
Other Duties & Responsibilities
Attends Restitution Hearings.
Learning and maintaining knowledge of the Medicare (CMS) process and identifying claims that are eligible.
Assists the Administrative Assistant as needed.
Qualifications
High school diploma and the equivalent of one year of technical or business school training; and
One to three (1 - 3) years related experience, or equivalent combination of education and experience.
Knowledge, Skills & Abilities
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Knowledge of:
Wisconsin Worker's Compensation Act, administrative code, and case law.
Claims handling practices and procedures.
Office machines and proficiency in the use of computers and computer software including Microsoft Word, Outlook, Excel, claims software (Origami), and other business software.
Medicare.
Ability to:
Handle sensitive situations in a professional manner that reflects favorably upon the member and the Company.
Effectively manage multiple assignments or tasks.
Effectively work as a member of a team, coordinating and completing assignments in a timely manner.
Communicate professionally, timely, and effectively, both orally and in writing.
Read and accurately interpret documents such as medical records and legal documents.
Accurately and efficiently write routine reports and correspondence.
Effectively and professionally present information and respond to questions from clients, claimants, medical service providers, and member representatives.
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MRA-The Management Association
tuition reimbursement
Oct 13, 2025