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Medical Only Claims Examiner (Workers' Comp)

Employer
ICW Group
Location
San Diego, California
Salary
Not Specified
Closing date
Jul 27, 2019

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Job Details

As a Med Only Claims Examiner at ICW Group, you will administer benefits in accordance with statutory and case law as well as pertinent regulations for an inventory comprised of minor injuries with no lost time. Reserve, manage and bring Workers Compensation claims to an equitable conclusion within the company standards and best practices guidelines. Maintain effective communications with other departments and maintains a good working relationship with customers.

ESSENTIAL DUTIES AND RESPONSIBILITIES

  • 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.

Requirements

  • High school diploma or general education degree (GED).
  • Must be state certified within 1 year of handling the Medical Only desk or certification along with 1-3 years insurance experience OR have an equivalent combination of experience and education.
  • Excellent verbal and written communication skills, time management and organizational skills.
  • Must be detail oriented, team players and have a sense of urgency for execution.
  • Excellent phone skills. Strong computer typing skills and data entry experience.
  • Attention to detail, ability to multi-task and strong prioritization skills.
  • Ability to read, write and comprehend simple instructions, short correspondence and memos.
  • Ability to effectively present information in one-on-one and small group situations to customers, clients and other employees of the organization.
  • Ability to add, subtract, multiply and divide using whole numbers, common fractions and decimals.
  • Ability to compute rate, ratio and percent, and to draw and interpret bar graphs.
  • Ability to apply common sense understanding to resolve issues and problems that arise.
  • Ability to deal with problems involving several concrete variables in standardized situations.

Company

 

ICW Header

 

Headquartered in San Diego, ICW Group is a multi-line insurer that provides coverage solutions to businesses through a network of independent agents and brokers. ICW Group offers three types of insurance—workers' compensation, earthquake and auto insurance. Known for meeting the needs of its policyholders, ICW Group prides itself on providing service that is truly customer-centric. In recent years, ICW Group has earned a reputation for helping policyholders achieve fewer and less costly claims. The company accomplishes this through extensive risk management expertise, highly proactive claims handling, and aggressive fraud monitoring.

At ICW Group, our focus and passion is offering great insurance products, services and experiences. We honor our commitments to our customers, our communities and each other to ensure that you have a better today and a safer tomorrow. With our home office in sunny San Diego, CA and with 10 branches across the U.S., ICW Group has over 40 years of experience in property and casualty insurance. Our passionate and creative team members are the power behind our successful business. 

A strategic investment in innovation today is critical to our success in the future. Our leaders welcome people who are eager to bring the power of innovation, the willingness to try something different or adopt a new approach or technology as we evolve to meet the needs of our customers and agents. Our culture fosters experimentation in models, processes, and products in an effort to move forward and help shape not only ICW Group’s future but the insurance marketplace as a whole. 

ICW Group is committed to the satisfaction of our customers and recognizes that satisfied, contributing Team Members are the foundation of a superior customer experience. With a team of 880, our enterprise is sized just right to provide broad challenging job responsibilities in a more personal environment. An important part of this personal approach to your success is our commitment to health and wellness. We provide a comprehensive program to help you maintain your total health because we believe that being at your personal and professional best is important to you and your family. 

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