Specialist Claims Administration III

Dublin, Ohio
Not Specified
Feb 19, 2019
Apr 19, 2019
Job Type
Not Specified
Career Level
Not Specified

York Risk Services Group is a premier provider of insurance, risk management, alternative risk, pool administration and claims management solutions to clients across hundreds of industries. Recently named by Forbes as one of "America's Best Midsized Companies Two Years in a Row" We firmly believe that our employees drive the success of the company. With success in mind as the ultimate goal, we strive to create and provide an environment that offers challenging, stimulating and financially rewarding opportunities.

Job Description

  • Maintain customer satisfaction by serving as primary contact for designated group of employers to ensure customer satisfaction and retention thru ongoing telephonic communication
  • Verify and follow up on remain at work ability for an injured worker with modified duty return or who is receiving vocational rehabilitation services in accordance with Company policies and procedures
  • Support medical management services:
    • Process C-9s according to CareWorks C-9 Scope of Processing
    • Enter data and maintain timely updates of information into Conduit system completing EDI updates to BWC as required by policy
    • Refer cases for case management (CM) triage/services based on: catastrophic claim, lost time claim with approval for surgery, pre-op testing, consulting physician recommending surgery, complications to work injury/illness based on company policy
    • Refer cases for case management services when requested by employer, injured worker
    • Verify return to work or remain at work status and treatment plan based on BWC Contact Scripts
    • Gather BWC RTW strategy information
    • Update Case Status in accordance with Company policies and procedures
  • Support vocational rehabilitation services:
    • Monitor and identify claims appropriate for referral based on BWC criteria
    • Monitor and document vendor progress notes to ensure compliance with Company and BWC policies and procedures
    • Provide updates to employer, BWC, and TPA if applicable
  • Identify areas for quality improvement and make recommendations to manager
  • Work in a team environment

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