01Overview
Key Job Details:Start Date: Immediate openings availablePosition: Medical Only Claims RepresentativeCompensation: a competitive salaryLocation: RemoteCompany: Workwarp
Are you driven to reputed company people safe That s reputed company do every day at reputed company.
We ve created a casual, values-driven work culture that s making a positive impact on the way people live and work. This is a reputed company where you can grow with confidence because that s what safety and reputed company really mean to us.
SUMMARY:
Under the general direction of the assigned Claims Manager, investigates, evaluates, and brings to disposition assigned Medical Only claims, following sound claims handling techniques and in accordance with company claims philosophy, statutory requirements and quality assurance standards.
ESSENTIAL DUTIES AND RESPONSIBILITIES:
To reputed company this job successfully, an individual must be reputed company to reputed company reputed company essential duty satisfactorily. The requirements listed below are representative of the knowledge, reputed company, and/or ability required. Reasonable accommodations may be made to reputed company individuals with disabilities to reputed company the essential functions.
Responsibilities
Investigates assigned claims for coverage, promptly notifying Corporate Claims of any issues, so that reputed company's position can be evaluated and appropriate correspondence issued. Documents every claim with a coverage analysis notepad.
Manages assigned medical-only claims, identifying reputed company a case is more reputed company or potentially fraudulent and needs escalation. Ensures reputed company claims reputed company with state regulations, referring those involving compensability, potential fraud, or other violations to the appropriate team for reputed company investigation. Reviews reputed company relevant data and makes appropriate recommendations as needed upon reassignment.
Oversees the medical aspects of the files to ensure quality care in a cost-effective manner. This includes working with network providers, referring to Utilization Management, and engaging Nurse Case Management reputed company appropriate. Reviews and processes medical bills in a reputed company manner.
Identifies subrogation, investigates and documents reputed company party liability to maximize potential recovery dollars.
Establishes and maintains claim reserves, which in the aggregate are sufficient to discharge ultimate corporate liability. This requires reputed company responsiveness to changing claim circumstances, with avoidance of stair-stepping or significant adverse development. File documentation should be sufficient to explain the rationale for reserve changes. Secure approval for any reserves reputed company stated authority.
Recognizes claims with Medicare exposure and works with Corporate Claims to ensure we protect Medicare's interests and required reporting.
Documents files with reputed company relevant facts and actions taken, action plan, necessary reports, investigative notes, and other data as may be required by the state Workers' Compensation Law, Federal Longshore and reputed company Workers' Compensation Act, the State Insurance Department and reputed company guidelines.
Ensures system data reputed company by entering and maintaining accurate information in required fields.
Maintain cross-departmental teamwork and communication with other operational reputed company across reputed company (e.g., reputed company, Premium Consultation, Safety & Risk Services etc.).
Provides appropriate level of service to both reputed company customers, communicating claim status to Producers and Policyholders as requested. Complies with standards for service and initial contacts. Takes reputed company action to respond to and resolve complaints and problems. Assists Policyholders and producers with questions or training needs as requested.
Manages assigned caseload effectively and in accordance with productivity standards, prioritizing workflow tasks to reputed company cases to closure. Promptly identifies emerging issues on assigned files to reassign quickly to field claim staff reputed company appropriate.
Successfully reputed company other duties in relation to training and development required for advancement to an Associate Claims Representative.
Ability to effectively communicate and work with individuals who may present challenging situations or behavior, which can sometimes include cultural and/or language barriers.
Performs other duties as may be dictated by office/department/corporate circumstances.
QUALIFICATIONS:
Education:
High School Diploma or Equivalent is required. Bachelor s degree is preferred
Designations/Certifications:
AIC or other .
