Claims Team Lead

3 weeks ago


Ontario, United States Cynet Systems Full time
Job Description:

Pay Range: $41hr - $46hr
  • Maintain contact with team via Microsoft Teams and phone calls for teambuilding and to provide assistance.
  • pprove overlimit payments process according to procedure.
  • Review and approve new claim determinations and provide initial directions as to whether to delay, deny, accept.
  • Review and approve litigation referrals and investigation referrals.
  • Review mail of candidate team, provide direction as needed.
  • Monitor for hearing dates and need for settlement authority requests or staffing of legal issues as they arise with examiner, DA, Director (if needed), County Representative (if needed).
  • Ensure team meets their monthly #'s for core duties (reports are sent to assist with this).
  • Review and ensure Medata suspended payments (bill review payments pending approval by examiner) are reviewed/processed by examiners.
  • Review and approve benefit notices prepared by examiners to ensure accuracy prior to mailing.
  • Review and approve benefits payments that exceed examiner's level and ensure appropriate documentation and paperwork is attached to the claim to support payment.
  • Ensure claim coding is accurate and required fields are updated.
  • Respond to email inquiries and phone calls to assist our customers.
  • Review claims for supervisor direction every 90 days or sooner depending on need.
  • Maintain diary on all claims with emphasis on lost time claims/and delays.
#monsterit
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