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Description
Overview:
Position Summary
Personally handles a case load of claims of varying complexity.
Responsibilities:
Essential Duties and Responsibilties
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Opens new claims, completes three-point contact, and performs needed investigations to determine compensability as well as possible subrogation or apportionment, according to state and/or office timeframes and guidelines.
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Sets appropriate reserves according to office timeframes and guidelines.
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Determines indemnity benefit according to office timeframes and guidelines.
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Follows appropriate procedures for system documentation to preserve data integrity.
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Monitors and maintains accuracy of reserves over the life of the claim; when new information is received, re-evaluates and recommends reserves according to office standards.
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Creates and executes action plans needed to bring case to closure.
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Makes timely payments according to statute.
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Makes required statutory filings and responds to requests within required time frames.
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Reviews medical bills and negotiates rates when applicable, then approves and pays, objects, or denies within time required.
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Brings in resources to assist on a claim but remains accountable for the outcome.
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Reviews incoming medical reports, evaluates treatment plans and progress, and works with providers and employers to expedite return to work; documents efforts to achieve a return to work plan for all lost time claims
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Directs or redirects medical treatment to network or preferred providers.
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Completes File Strategy/Claims Management Updates (CMU) on time according to office standards
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Reviews all settlements and reserve transactions with supervisor.
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Handles a caseload of varying complexity/exposure claims.
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Meets quality and monthly productivity objectives according to company standards.
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Proactively manages claims to timely closure.
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Completes detailed settlement evaluations and recommends appropriate settlement value, within authority; negotiates claim settlements with injured workers and/or injured workers attorneys.
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Meets monthly productivity objectives according to office standards.
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Maintains regular contact with injured workers, employers and agents to develop positive relationships and establish credibility.
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Communicates with doctors, providers, attorneys, co-workers, and others in a professional and prompt manner; returns phone calls within 24 hours.
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Work productively and harmoniously with others on a consistent basis.
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Respond positively to direction and criticism of performance
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Consistently maintain professional and appropriate demeanor.
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Perform other duties as assigned.
Qualifications:
Education, Skills and Experience Requirements
Minimum 1 year Claims handling experience
Strong verbal and written communication skills with emphasis on telephone communication required.
Strong math and reading skills required.
PC literacy required.
Holds any all legally required certifications in good standing according the jurisdictions in which the examiner is working.
Preferred Skills
Bilingual Spanish strongly preferred
Attendance Requirements
Due to the nature of the needs in the office, regular and reliable attendance is required. Must be able to work at least 37.5 hours per week, Monday through Friday, and be available as situations arise requiring extended hours.
Physical, Mental & Sensory Requirements
Designated Special Designated
Function % Requirements Yes/No Function Degree
Sitting 100% Hand Manipulation Yes Mathematics Med
Walking 0% Reaching Yes Reading High
Standing 0% Grasping Yes Verbal High
Bending 0% Visual Yes Written High
Kneeling 0% Auditory Yes Reasoning High
Lifting 0% Driving Yes
Air Travel No
Details:
Job Id:
32524765
Posted / Updated:
2/27/2012 3:45:08 AM
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