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CO Denver-West Regional Office
R2173 Casualty Med Pay No-Fault Technician (Open)
The Casualty Med Pay No-Fault Technician position supports the Personal Lines Division goal of ensuring industry-leading customer service and works with business partners to deliver seamless claim service. This position manages Med Pay and/or No-Fault claims of minor to moderate complexity. This may include review of loss report, communication with all parties and making claim payments. Continues to develop skills and insurance and medical knowledge required of this position.
Primary AccountabilitiesFile Management (35%)
- Conducts initial review of claims received to identify prior actions taken and determine next steps.
- Manages electronic claim system activities including inbox, referrals, suspense, files documentation and filing of new documents.
- Administers payment of related bills and wage loss. Reviews medical bill reconsiderations and state specific requirements.
- Actively manage claim inventory and work toward cycle time goals of closing files.
- Collaborates with business partners to provide seamless customer service.
- Makes independent decisions as self-supervises some files, however, recognizes when assistance is needed.
- Identifies Medicare eligibility and completes Medicare notifications as appropriate.
- Assists claims from other adjusters` inventories and responds to customer inquiries, makes appropriate decisions and closes files as needed.
- Responsible for administrative support including fielding phone calls, responding to e-mails, faxes, and medical bill requirements.
Policy Determination & Analysis (15%)
- Within authority investigates medical claims for proximate cause and mechanism of injury by contacting the appropriate parties including insureds, claimants, witnesses, agents, etc.
- Checks for prior claims, recognizes exposures, open appropriate perils. Requests and reviews medical records as needed.
- Identifies, investigates and evaluates subrogation and contribution opportunities and submits referrals as appropriate.
- Perform ISO searches and updates information.
Business Partnerships (15%)
- Interprets and determines state-specific differences in policies and contract coverages, utilizes company Claim Bulletins, manuals and best practices.
- Applies decision making process to available data to determine coverage or non-coverage and communicates to manager.
- Establishes rapport with business partners (agency, personal lines, legal, medical services, SIU, or other business partners) and builds ongoing relationships by including stakeholders in the claim handling process as appropriate.
- Partners with others to provide seamless customer service.
- Facilitates communication between customers, agents, vendors, third party administrators and other employees. Provides agents with important claim related information; provides all parties with claim process and status as appropriate; answers questions or redirects to other areas.
- Explains and discusses any circumstances that may affect customer service with agency, vendors, third party administrators or other claim personnel. Includes others in problem resolution as appropriate.
- Sets reserves within authority and recommends settlement values when loss exceeds authority.
- Provides clear explanation of payment/denial to medical provider, answers all questions and processes the payment.
- Recognizes, controls and resolves disputes with tact and diplomacy. Recognizes when assistance is needed and obtains it.
Specialized Knowledge and Skills Requirements
- This position requires travel up to 10% of the time.
- Demonstrated experience providing customer-driven solutions, support or service
- Basic knowledge and understanding of claim handling process.
- Basic knowledge of medical claims terminology.
- Basic Knowledge of claims processing systems.
- Demonstrated strong communication skills with customers and medical providers.
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