Job Description

Education & Licensing

·        Bachelor's degree from an accredited college or university preferred.

Experience

·        Two (2) years of claims management experience or equivalent combination of education and experience or successful completion of Claims Representative training required.

Skills & Knowledge

·        Developing 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 literate, including Microsoft Office products

·        Analytical and interpretive skills

·        Strong organizational skills

·        Good interpersonal skills

·        Ability to work in a team environment

·        Ability to meet or exceed Service Expectations

ESSENTIAL FUNCTIONS and RESPONSIBILITIES

·        Processes low level 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 coordinates low level workers compensation claims' action plans to resolution, return-to-work efforts, and approves claim payments.

·        Approves and processes assigned claims, determines benefits due, and administers action plan pursuant to the claim or client contract.

·        Administers 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 low-level lifetime medical and/or defined period medical claims which include state and physician filings and decisions on appropriate treatments recommended by utilization review.

·        Maintains professional client relationships.