Job Details
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POSITION: Claims Technician
DEPARTMENT: Claims Management Division
REPORTS TO: Medical Only Supervisor
Position Requirements:
High school graduate or equivalent; higher education beneficial.
Workers' Compensation claims experience and/or knowledge preferred but not mandatoryt.
State adjusters' license required within the first year of employment.
Highly developed organizational skills and ability to establish priorities. Mathematical/accounting aptitude and excellent analytical, problem-solving abilities required. Ability to anticipate needs and exercise independent judgment.
Strong interpersonal skills to deal effectively with all levels of the organization, the public and customers with tact and diplomacy
Primary Accountabilities:
Gains basic knowledge of Department Errors and Omissions Exposures and implementation of Department E&O Procedures.
Ensures optimum performance in this function and recommends and implements techniques to increase productivity or department procedures.
Develops and maintains an image of corporate excellence and teamwork with emphasis on professional and credible customer service and company relations.
Consistently utilizes all (appropriate or necessary) Office products and databases available to enhance position productivity
Continually strive to upgrade skills and knowledge through on-the-job training, utilizing corporate library, and attending related seminars and courses.
Accurate claims adjudication by assessing all information to determine compensability:
Analyzes loss information upon receipt of medical only claims; investigates said claim through interviews with claimants, insured, attorneys and medical providers to determine legitimacy of the claim.
Maintains current and accurate diaries on a daily basis.
Interfaces with Group Self Insurance and Single Self-Insured Management Team, Fund Administrator and claims management division personnel, insureds, health providers and attorneys regarding med only claims activity. Partners with employer in effective claims management.
Reviews and Authorizes claim payments within authority.
Complies with all state mandated requirements.
Attends & presents employer/insurer's position at mediations held by the workers' compensation board and has full authority to negotiate resolution of disputed issues.
May negotiate smaller settlements with insureds, attorneys and claimants.
Positive and effective co-worker relations:
Focus on team goals and objectives
Courteous and considerate communications
Accurate assistance and support to others as needed.
The above describes the primary functions of this position; however, should not be considered a detailed description of all assigned tasks.