Senior Workers' Compensation Claims Technician

Are you looking for an opportunity to join a claims team with a fast-growing company that has consistently outpaced the industry in year-over-year growth? Liberty Mutual Insurance has an excellent claims opportunity available for a Workers Compensation Claims Technician (Medical Only). This position may be filled as a Workers Compensation Claims Technician or Workers Compensation Senior Claims Technician.

GRS North America Claims offers flexibility to work from home full-time. Candidates selected for this position will be trained remotely. Open to Nevada-based candidates only. Candidates residing within 50 miles of Las Vegas, NV should be able to accommodate an onsite requirement of up to two days per month.

About the role

Claims Technicians obtain essential information to process routine workers' compensation (WC) claims with ongoing medical management for medical pension claims. Provides injured workers and customers with accurate, timely information and quality service. Claims Technicians also identify potential problems and make claim referral decisions.

Responsibilities

• Conduct investigation to secure essential facts from injured workers, employers, and providers regarding workers' compensation through telephone or written reports.
• Verify information from claimants, physicians, and medical providers to assess compensability and/or causal relation of medical treatment and make evaluations for cases with claim-specific ongoing medical management.
• Provide ongoing medical case management for assigned claims.
• Initiate calls to injured workers and medical providers if projected disability exceeds maximum triage model projection or to resolve medical treatment issues as needed.
• Maintain contact with injured workers, providers, and employers to ensure understanding of protocols, claims processing, and medical treatment.
• Continually assess claim status to determine if problem cases or those exceeding protocols should be referred to Claims Service Team and/or would benefit from MP RN review or other medical/claims resources.
• Arrange Independent Medical Exam and Peer Review as necessary.
• Maintain accurate records and handle administrative responsibilities associated with processing and payment of claims.
• Record and update status notes; document results of contacts, relevant medical reports, and duration information per file posting standards including making appropriate medical information viewable to customers in Electronic Document Management (EDM).
• Generate form letters following set guidelines (e.g., letters to physicians projecting disability, letters confirming medical treatment and disability, and letters outlining expected outcome to employers).
• Authorize payment of medical payments and/or medical treatment.
• Recognize potential subrogation cases, prepare cases for subrogation, and refer these cases to the Subrogation Units.

Requirements

• High school diploma plus 1-3 years of related customer service experience or applicable insurance knowledge.
• Licensing required in some states.
• Effective analytical skills required to learn and apply basic policy/contract coverage and recognize questionable coverage/contract situations (which necessitate supervisory involvement) along with effective interpersonal skills to explain the facts and logic used to arrive at decisions in a way the customer understands.
• Effective written skills to compose clear, succinct descriptions when posting files and drafting correspondence.
• Good telephone and typing skills required.
• Ability to learn when to make proper use of medical management resources, know when to use them, and follow through with medical management information received.

Benefits

At Liberty Mutual, our goal is to create a workplace where everyone feels valued, supported, and can thrive. We build an environment that welcomes a wide range of perspectives and experiences, with inclusion embedded in every aspect of our culture and reflected in everyday interactions. This comes to life through comprehensive benefits, workplace flexibility, professional development opportunities, and a host of opportunities provided through our Employee Resource Groups.

We value your hard work, integrity, and commitment to making things better, and we put people first by offering benefits that support your life and well-being. To learn more about our benefit offerings, please visit: Liberty Mutual Benefits.

Pay

The typical starting salary range for this role is determined by a number of factors including skills, experience, education, certifications, and location. The full salary range for this role reflects the competitive labor market value for all employees in these positions across the national market and provides an opportunity to progress as employees grow and develop within the role. Some roles at Liberty Mutual have a corresponding compensation plan which may include commission and/or bonus earnings at rates that vary based on multiple factors set forth in the compensation plan for the role.