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Specialist Claims Administration III

Employer
York Risk Services Group
Location
Dublin, Ohio
Salary
Not Specified
Closing date
May 6, 2019

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Job Details

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

  • 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

Company

For more than 55 years, York has been delivering on our mission of reducing risk and getting people and organizations back to health, work and productivity. We’re committed to recruiting, developing and retaining people who represent our values and who believe in our mission. Our associates come from all walks of life but are single-minded in the pursuit of doing right by those we serve. We want each experience for our clients to be marked by expertise, consistency, and compassion because that’s what sets us apart. And we know for certain that it’s our people who allow us to say, boldly and proudly, that York is behind every good outcome.

Company info
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