Claims Team Lead

3 weeks ago


Ontario, United States CMJobPoster Full time

Job Title: Claims Team Lead
Location (On-site, Remote, or Hybrid?): Ontario, CA (hybrid)
Contract Duration: Contract until 11/16/2024

Description:
County of Los Angeles experience preferred
10 years of experience in workers compensation. Self insurance certificate mandatory.

Job Description:

  • Maintain contact with team via Microsoft Teams and phone calls for teambuilding and to provide assistance
  • Approve 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 your 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

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