Administers benefits in accordance with statutory and case law as well as pertinent regulations for an inventory comprised of minor injuries with no lost time. Reserves, manages and brings Workers Compensation claims to an equitable conclusion within the company standards and best practices guidelines. Maintains effective communications with other departments and maintains a good working relationship with customers.
Moves inventory to closure or upgrades as injuries evolve.
Manages medical treatment to bring files to closure.
Assesses reserves appropriately and timely with authority level not to exceed $2,500.
Pays bills appropriately and timely.
Receives and reviews information related to Medical Only claims.
Communicates via mail, phone and email with injured workers, employers and medical providers.
Sets up file diaries, document follow-up care and other claim related activities.
Follows up with medical providers to obtain results.
Supports the process by scheduling medical or testing appointments to determine appropriateness of medical care being received related to injury.
Authorizes/certifies medical treatment in line with Utilization Review Regulations and as outlined within department UR plan.
Reviews and respond to incoming mail, emails, telephone calls, and fax transmissions from providers and injured workers.
Takes actions required to respond to mail.
Reviews and approves or denies medical bills, and returns bills with insufficient information.
Processes bills in the bill paying and tracking system or issues for processing by others.
Identifies, investigates, and pursues subrogation cases.
Responsible for bringing files to supervisors attention when issues become complex.