Associate Claims Specialist - Medical-Only - Workers Compensation

Old Republic Commercial Risk; Fresno (CA); On-site; USD 58,000 - 73,000; Full time

Job summary

Old Republic Commercial Risk is seeking a remote claims professional to manage medical-only and limited lost time claims, and to oversee permanent total claims with a focus on minimizing losses while providing excellent customer service. The role requires 1+ year of workers' compensation claims handling, knowledge of medical terminology, and strong organizational and communication skills.

Responsibilities include prompt file setup, payments, diary management, and ensuring compliance with

Qualifications

• High school diploma or equivalent required.
• 1+ years of Workers Compensation claims handling experience preferred.
• Proficiency with medical terminology and documentation.

Responsibilities

• Contact accounts on First Notices of Loss to obtain missing information for file setup.
• Process payments, answer phone calls, and authorize medical treatments for Medical Only claims.
• Maintain timely diary notes and complete contacts within 24 hours of assignment.
• Assess treatment appropriateness and relation to injury.
• Directs treatment to network physicians as appropriate.
• Refer subrogation or permanency claims to Supervisor.
• Ensure compliance with jurisdictional requirements and licensing.
• Monitor benefits on Permanent Total or Death cases and notice changes in life/work status.

Skills

Strong organizational skills

Excellent verbal and written沟通 skills

Education

High school diploma or equivalent

Tools

MS Excel

MS Word

Job description

As a member of our Claims team, you will proactively manage medical only and limited lost time claims in order to minimize losses, manage permanent total claims in order 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, authorize treatment associated with Medical Only claims
• Complete appropriate contacts within 24 hours of assignment, and establish and maintain appropriate diary for follow-up
• Determine whether 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
• Work to ensure compliance with all appropriate jurisdictional requirements on Medical Only claims, including timely form filing if applicable
• Maintain a working knowledge of jurisdictional requirements and obtain/maintain state adjusting licenses
• Administer benefits on Permanent Total or Death cases, which includes monitoring for changes in life or work status, implied interest in resolution or marked increases in costs.
• Demonstrate commitment to Company’s Code of Business Conduct and Ethics, and apply knowledge of compliance policies and procedures, standards and laws applicable to job responsibilities in the performance of work.
• Target Salary - $58,000 - $73,000

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 skillsExcellent verbal and written communication skills
• Proficiency MS Excel and MS Word.
• Remote position