Claim Administrator
- Employer
- Davies Claims Solutions
- Location
- Citrus Heights, California
- Salary
- Salary commensurate with experience. Medical, dental, vision, 401(k), generous PTO bank and more.
- Closing date
- Oct 12, 2020
View more
- Category
- Claims
- Job Type
- Full Time
- Career Level
- Experienced (Non-Manager)
Job Details
SUMMARY:
Performs support functions and must be willing to serve as entry level claims adjuster responsible for handling a small volume of medical only worker’s compensation claims. This position is an entry-level technical position and works closely with a Senior Claim Adjuster or a Supervisor.
JOB REQUIREMENTS:
- Receive loss notices via fax or telephone
- Set up claims and forward to adjusters
- Assists adjusters with required state filings, file
- Prepare benefits notes to start WC benefits
- Prepare PQME, IMR, IBR packets
- Maintain appropriate registers
- Complete data entry, check issuance and vouchers
- Maintain policy status information, required logs, and monthly reports
- General clerical duties – i.e. providing support to adjusters by sending faxes, letters, wage statements, contact cards, etc.
- Determines coverage, compensability and if necessary transfers claim
- Utilizes appropriate vendor(s) for medical bill review
- Processes medical payments and all other bills
- Must have basic knowledge of current principles and practices associated with claims investigations
- Must be able to understand oral and written policies, procedures or instructions
- Ability to handle confidential medical information
- Respond to clients in a timely and courteous manner
- May include other assigned duties
REQUIRED KNOWLEDGE, SKILLS AND ABILITIES:
- Ability to understand and follow oral and/or written policies, procedures and instructions
- Ability to perform a wide variety of duties and responsibilities with accuracy and speed, while meeting time-sensitive deadlines
- General knowledge of claims and ability to identify claims of urgent priority
- Must have good oral and written communication skills
- Excellent telephone and customer service skills
- Good understanding of personal computers and ability to use various software
- Ability and willingness to learn new skills and knowledge brought about by rapidly changing information and/or technology
Required Experience:
Prefer to have 2-5 years experience in claims office or equivalent business experience. Should have basic knowledge of insurance coverages. Experience in adjusting MO claims is a plus. Must have high school diploma or equivalent.
Company
Davies Claims Solutions provides TPA services for a variety of insurance clients and self-insured entities including public entities and private employers with employees in many states.
The workers’ compensation TPA claims handling process includes a number of services such as nurse case management, nurse triage, medical bill review, pharmacy benefit management, telemedicine, medical provider options, return-to-work initiatives, peer review, utilization review and more.
As a TPA, we provide a number of flexible client options, such as choice of nurse case management, medical provider access with PPO networks or Alternative Cost Containment, and a choice of surveillance and claims investigation. We also offers telemedicine as a managed care solution.
Our U.S. claim adjusters, have an average of 25 years of industry experience. We have a strong track record of delivering excellent financial outcomes for our clients such as averaging indemnity savings of almost a third through our pharmacy benefit management.
- Website
- http://www.ascrisk.com/
- Location
-
2501 McGavock Pike, Suite 802
Nashville
TN
37214
US
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