Senior Workers Compensation Claims Technician
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Liberty Mutual has an immediate opening for a Senior Workers Compensation Claims Technician II. The Senior Workers Compensation Claims Technician II, under limited supervision, obtains essential information to manage the reserves and payments for stable, complex workers' compensation (WC) claims. In this role, you will evaluate treatment plans and causal relationships by securing essential facts and documentation from injured worker, employer, providers, and others. You will continually assesses claim status to determine if problem cases or those exceeding protocols should be referred to others. This is the top-level WC Claims Technician job in the Medical Management Unit/Medical Payment job family.
- Verifies information from claimants, physicians, and policyholders to evaluate treatment plans and causal relationship of plans and injuries/body parts.
- Establishes action plans based on case facts, best practices, protocols, jurisdictional issues and available resources (e.g., arranges Independent Medical Exam, Peer Review, Surveillance/dependency/life pension checks). Resolution strategies should clearly reflect the file status and disposition strategy.
- Ensures appropriateness of ongoing pension and lifetime benefits. Ensures alive-and-well checks are complete by TPAs and SAPs for widow cases, active treatment and restrictions continue to be adhered to, and proper payout of large dollar permanency settlements.
- Establishes and maintains proper reserves within ongoing resolution strategies and through management of financial notes. Requires a level of independent analysis of cost trends and future medical exposure. Interacts with the insured, makes reserve recommendations and adjustments pending authority during processing of the claim. Thorough analysis of significant cost trends is performed, often utilizing Examining and CCMU resources.
- Analyze cases for potential settlement, third-party recovery, and referrals.
- Reviews closed file updates to determine whether claim is to be re-opened or remain closed.
- Updates files and provides comprehensive reports as required and to support the need for outside services such as surveillance, rehabilitation, and healthcare management.
- Ensures all state required filing forms are completed in accordance with appropriate rules.