Associate Claims Specialist - Medical-Only - Workers Compensation
PMA Companies · Anaheim, CA, US
20 days agoImpress employers and recruiters.
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About the Role
Proactively manage medical only and limited lost time claims to minimize losses and provide superior customer service.
Responsibilities
- Contact accounts on First Notices of Loss to obtain missing information pertinent to file set-up.
- Process payments, answer phone calls, and authorize treatment for Medical Only claims.
- Complete appropriate contacts within 24 hours of assignment and establish/maintain follow-up diaries.
- Determine if 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.
- Ensure compliance with jurisdictional requirements on Medical Only claims, including timely form filing.
- Maintain knowledge of jurisdictional requirements and obtain/maintain state adjusting licenses.
- Administer benefits on Permanent Total or Death cases, monitoring for changes in status or costs.
- Demonstrate commitment to Company’s Code of Business Conduct and Ethics, applying compliance knowledge to job responsibilities.
Requirements
- High school diploma or equivalent.
- One or more years of Workers Compensation claims handling experience.
- License required or ability to obtain license within 90 days of employment in mandated states.
- Familiarity with medical terminology.
- Ability to work independently, handle multiple tasks simultaneously, make difficult decisions, and focus on details.
- Strong organizational skills.
- Excellent verbal and written communication skills.
- Proficiency in MS Excel and MS Word.
Skills
- Medical terminology
- Independent work
- Multitasking
- Decision making
- Attention to detail
- Organizational skills
- Verbal communication
- Written communication
- MS Excel
- MS Word
Experience Level
- One or more years
Education Level
- High school diploma or equivalent