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To perform workers’ compensation claims adjudication and investigation. Responsible for all technical aspects of claim management for assigned including compliance with all established performance guidelines.
- Properly investigate and handle all types of workers’ compensation files including lost time, litigation and long term exposure within predetermined claim-handling guidelines.
- Initiate return-to-work discussions with the employer and effect return-to-work for the injured worker.
- Establish timely and appropriate case reserves
- Investigate and manage subrogation and negotiate settlements.
- Use automated diary system to issue indemnity benefits and provide claim management.
- Accurately calculate and pay wage loss and other benefits.
- Assign rehabilitation and monitor costs and outcomes.
- Document all action plans and evaluations for claim resolution.
- Maintain organized electronic files.
- Interact with clients to establish/improve communication and service capabilities.
- Interact and communicate with state agencies, attorneys and other providers.
- Address customer complaints and inquiries in an exemplary and professional manner.
- Achieve specific performance outcomes related to quality and quantity of work as established by management.
- Provide cost containment for individual claim and overall claim costs for account to achieve account profitability.
- Define medical and rehabilitation payment parameters staff.
May perform other functions as assigned.