Posted 1 year ago in Insurance
WORKERS' COMPENSATION EXPERIENCE REQUIRED
Provide clerical and technical assistance to Senior Claims Examiners and administer Medical Only claims, ensuring timely processing of claims and payment of benefits, managing and directing medical treatment, and setting reserves.
PRINCIPAL DUTIES AND RESPONSIBILITIES
Incumbent must have the skills, ability and judgment to perform the following essential job
duties and responsibilities with or without reasonable accommodation. Process new claims in compliance with client’s Service Agreement
Issue all indemnity payments and awards on time
Process all approved provider bills timely
Prepare objection letters to providers for medical bills; delayed, denied, lacking reports.
Answer questions over the phone from medical providers regarding bills
Contact treating physician for disability status
Contact employer for return to work status or availability of modified work.
Contact injured worker at initial set up
Send DWC notices timely
Issue SJDB Notices timely
Request Job Description from Employer
Handle Medical Only claim files
Calculate wage statements and adjust disability rates as required
Keep diary for all delay dates and indemnity payments
Documents file activity on computer
Update information on computer, i.e. address changes, etc.
Schedule appointments for AME, QME evaluations
Send appointment letters, issue TD/mileage, send medical file
Schedule interpreter for appointments, depositions, etc.
Request Employer’s Report, DWC-1, Doctor’s First Report if needed
Verify mileage and dates of treatment for reimbursement to claimant
File and serve documents on attorneys, WCAB, doctors
Serve PTP’s with medical file and Duties of Treating Physician (9785)
Request PD ratings from DEU
Draft Stipulated Awards and C&R’s
Submit C&R, Stipulated Awards to WCAB for approval with documentation
Process checks – stop payment, cancellations, void, journal payments
Handle telephone calls for examiner as needed
Complete penalty calculations and prepare penalty worksheets
Complete MPN,HCO and/or EDI coding
Complete referrals to investigators
Complete preparation of documents for overnight delivery
Work collaboratively with Senior Claims Examiners, Nurse Case Managers and other
Assistant Claims Examiners
Contact with clients, injured workers, attorneys, doctors, vendors and other parties
Provide updates of claims status to Senior Claims Examiner's and management
ESSENTIAL JOB REQUIREMENTS
The requirements listed below are representative of the knowledge, skill, and/or ability required.
Knowledge of workers’ compensation laws, policies and procedures
Verbal and written communication skills
Mathematical calculating skills
Computer processing skills
Ability to operate general office equipment
Ability to work in a paperless environment
Working knowledge or related information systems, including
Microsoft Office (Word and Outlook)
Welcome to Essential Staffing, where we are profoundly dedicated to recruiting and staffing. Our core values of commitment and integrity drive our intense desire to obtain the best results for our clients, employees, and candidates.
Commitment. Dedication to a long-term course of action. We are committed to acting in the best interests of our clients, candidates, and employees.
Integrity. The quality or state of being of honest and sincere. In our relationships with clients, employees and candidates, we value honesty, fairness, and respect
Results. The consequence or consequences desired. We deliver the best results by doing the basics of our business superbly well.
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