At York, we believe that an experience marked by expertise, consistency and compassion sets us apart. And we celebrate the diverse backgrounds and unique perspectives that allow us to stand apart from our competitors. Thats why we are committed to recruiting, developing and retaining people who represent our values and who believe in our mission.

Job Description

This individual is responsible for handling from inception to completion simple and straight-forward work related injuries that do not involve any lost time from work. The Medical Only Claims Examiner is responsible for maintaining current file documentation, which coincides with the progression of the file; must be able to communicate effectively orally and in writing in order to monitor the direction of the medical treatment

• Document all incoming medical reports.
• Contact the employer to confirm no lost time and no red flags.
• Review the medical reports for accuracy and consistency in relation to the employers report and the original body part that was injured.
• Review claims every 30 to 45 days to ensure file progression.
• Authorize medical treatment, physical therapy and medications as directed in the instructions placed in the file.
• Investigate, manage, and resolve simple medical claims.
• Must possess a general understanding of all products and services.
• Monitor regulatory compliance to ensure such requirements are met within defined parameters.
• Have a general understanding of all legislative requirements and is able to take direction to meet those requirements in a prudent business manner.
• Maintains a license for all states and products serviced as required.
• Organize and update all reference material to reflect current legislation and regulatory compliance.
• Comply with all quality control standards set by the company for the handling of claims. Comply with all procedures set forth by the company for performing the job as it relates to the various components of claim administrative services.
• Ability to respond to common inquiries or complaints from clients, regulatory agencies, or members of the business community.
• Immediately notify Management of any unusual lawyer inquiries, insurance carrier inquiries, or department of insurance inquiries.
• Have a general understanding of all E & O liabilities and keep current and accurate documentation to support claims paying practices.

EDUCATION:

• BS / BA or Equivalent Work Experience

EXPERIENCE:

• 1 Year

SKILLS/ABILITIES:

• Ability to prioritize and juggle multiple tasks simultaneously
• Effective communicator both orally and in writing
• Strong customer service focus

KNOWLEDGE:

• Familiarity with workers compensation medical terminology