Associate Claims Specialist - Medical Only

Responsibilities

• Contact accounts on First Notices of Loss to obtain missing information pertinent to file set-up
• Process payments, answer phone calls, authorize treatment associated with Medical Only claims
• Complete appropriate contacts within 24 hours of assignment, and establish and maintain appropriate diary for follow-up
• Determine whether treatment is appropriate and causally related to the compensable injury
• Redirect treatment to network physicians as appropriate
• Refer subrogation potential claims or potential permanency claims to Supervisor
• Work to ensure compliance with all appropriate jurisdictional requirements on Medical Only claims, including timely form filing if applicable
• Maintain a working knowledge of jurisdictional requirements and obtain/maintain state adjusting licenses
• Administer benefits on Permanent Total or Death cases, which includes monitoring for changes in life or work status, implied interest in resolution or marked increases in costs

Requirements

• High school diploma or equivalent
• One or more years of Workers Compensation claims handling experience
• Licenses required or ability to obtain license within 90 days of employment in mandated states - FL, GA, AL
• Familiarity with medical terminology
• Strong organizational skills
• Excellent verbal and written communication skills
• Proficiency MS Excel and MS Word