Assist in the processing of workers’ compensation claims by performing technical and clerical duties as directed by the Claims Examiner or Supervisor. Work within a team environment to meet time sensitive filing requirements as well as maintain a current workload. May investigate workers’ compensation injury/illness claims, documents claims handling, and pays and/or denies benefits in a caseload of primarily medical only (MO) workers’ compensation claims. Limited indemnity (disability) claims may be assigned to technician for training purposes, at supervisor discretion.
- Request information from or provide information to the employee, employer, providers, attorneys, co-workers, state specific WC Division, 3rd parties, and others as directed. (via telephone, mail, or fax)
- Form completion
- Check issuance and related auto pay entry as appropriate
- Determine accuracy of employee reimbursement requests
- Accurate and timely electronic documentation of your work activity
- Resolve issues and inquiries regarding medical treatment bills
- Resolve claims related address, coding, vendor, and accounting issues
- Maintain organization of claim files
- Provide professional customer service to all internal and external customers
- Serve and file state forms when required.
- Receive and respond to telephone inquiries. This includes but is not limited to contact with injured employee and/or employer. Ability to contact health care provider to obtain information.
- Manage caseload with assistance of computer-operated diary and maintain current diaries. Ultimate goal is to reach conclusion of claim and close file as soon as medically indicated.
- Participates in on-going training opportunities to remain current on all aspects of claims handling and customer service.
- File recalculations
- Indemnity benefit escalations/reserves/payments
- Medical/Expense bill approval/payment
- Annual contact coordination
- All WC claim positions need to perform the duties noted in the position descriptions in accordance with the BRAC Claim Handling Guidelines - Workers' Compensation.
The W.C. Claim Technician may include the following additional tasks:
- Calculation and entry of reserves on assigned Permanently and Totally Disabled claims
- Investigate claims for compensability by analyzing claims-related information and applying BRAC guidelines.
- Verify active policy/coverage on new claims and determine if claim involves medical benefits only or includes exposure for lost time.
- Establish case reserves consistent with exposure on new claims. Examine reserves on a regular basis and adjust reserves if there is a significant change in exposure.
- Investigate subrogation issues on claims, and place responsible third parties on notice of our client’s subrogation interest. Pursue subrogation or transfer file as appropriate for each case.
- Authorize payment of bills for reasonable and necessary medical treatment, expenses associated with claims investigations and obtaining records. Send bills and records for audit when appropriate.
- Authorize or deny medical benefits within established time frames.
May perform other functions as assigned.