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Claims Examiner
3 months ago
Pay Range: $45hr - $50hr
Responsibilities:
- Manages workers compensation claims determining compensability and benefits due on long term indemnity claims, monitors reserve accuracy, and files necessary documentation with state agency.
- Develops and manages workers compensation claims' action plans to resolution, coordinates return-to-work efforts, and approves claim payments.
- pproves and processes assigned claims, determines benefits due, and manages action plan pursuant to the claim or client contract.
- Manages subrogation of claims and negotiates settlements. Communicates claim action with claimant and client.
- Ensures claim files are properly documented and claims coding is correct.
- May process complex lifetime medical and defined period medical claims which include state and physician filings and decisions on appropriate treatments recommended by utilization review.
- Maintains professional client relationships.
- Bachelor's degree from an accredited college or university preferred.
- Four years of claims management experience or equivalent combination of education and experience required.
- Working knowledge of regulations, offsets and deductions, disability duration, medical management practices and Social Security and Medicare application procedure as applicable to line of business.
- Excellent oral and written communication, including presentation skills PC liteXX, including Microsoft Office products Analytical and interpretive skills.
- Strong organizational skill Good interpersonal skills Excellent negotiation skills.
- bility to work in a team environment Ability to meet or exceed Service Expectations.
