Sr Claims Representative
Sr Claims Representative
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Job Description
Essential Duties and Responsibilities include the following. Other duties may be assigned:
- Interviews telephones or corresponds with claimant and witnesses consults police and hospital records.
- Contacts physicians to obtain medical diagnoses and projected treatment plans.
- Monitors medical progress of claimants and coordinates followup treatments; reports to employers including any restrictions that may be imposed on claimants return to work.
- Documents all information from contacts with employers claimants physicians and attorneys into the claims management system and ensures that documentation is current.
- Calculates and sets reserves through a reserve worksheet including the nature and scope of claims; adjusts reserves to reflect ultimate known exposures.
- Issues medical indemnity legal and expense payments
- Prepares reports for excess carriers and requests reimbursement when needed.
- Sets reminders to followup on tasks through diaries on the system; reviews and completes diaries daily.
- Maintains physical files for claimrelated documents such as medical information legal reports and other correspondence.
- Calculates and issues indemnity benefits such as temporary total disability (TTD) and permanent disability in a timely manner and in accordance with applicable state laws.
- Assigns case managers or vocational rehabilitation counselors as necessary.
- Reviews claims information from ISO Index Bureau)
- Conduct onsite investigation of claims if circumstances require it.
- Determine necessity of legal defense coordinates and monitors litigation with attorneys.
- Reviews claims submissions for thoroughness and accuracy.
- Determines compensability of claims through information gathered and according to workers compensation statutes; makes recommendations as to compensability and coverage of claims.
- Processes medicalonly workers compensation claims involving minor injuries and /or payment
- Provides guidance and advice to clients on direction of claims after all information has been gathered and analyzed.
- Ensures jurisdictional filings are complete and timely.
- Obtains precertification approval for specific treatments as needed.
- Prepares reports every 90 days or as requested for excess carriers regarding cases with catastrophic injuries; requests recoveries and follows up for receipt of monies.
- Reviews bills and medical notes; authorizes and codes bills.
- Prepares periodic written file reviews and attends meetings for specific clients to discuss claims statuses current reserves litigation statuses (if any) and future action plans outlined by contracts or requested by client(s).
Acrisure is committed to employing a diverse workforce. All applicants will be considered foremploymentwithout attention to race color religion age sex sexual orientation gender identity national origin veteran or disability status. California residents can learn more about our privacy practices for applicants by visiting the Acrisure California Applicant Privacy Policy available at Executive Search Firms & Staffing Agencies: Acrisure does not accept unsolicited resumes from any agencies that have not signed a mutual service agreement. All unsolicited resumes will be considered Acrisures property and Acrisure will not be obligated to pay a referral fee. This includes resumes submitted directly to Hiring Managers without contacting Acrisures Human Resources Talent Department.
Required Experience:
Senior IC
Employment Type
Full-Time
