Associate Claims Specialist - Medical-Only - Workers Compensation

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

Job summary

Old Republic Commercial Risk in Walnut Creek, CA, seeks a claims professional to manage medical-only and limited lost time claims, aiming to minimize losses and deliver superior customer service.

You will contact accounts on first notices of loss, process payments, authorize treatments, maintain follow-up diaries, and ensure regulatory compliance while coordinating with the network of physicians and vendors.

Strong organizational skills and proficiency with MS Excel and Word are essential.

Qualifications

• High school diploma or equivalent.
• At least 1 year of Workers' Compensation claims handling experience.
• License required or obtainable within 90 days in mandated states.
• Familiarity with medical terminology.

Responsibilities

• Contact accounts on First Notices of Loss to obtain missing file information.
• Process payments, answer calls, and authorize medical treatment for Medical Only claims.
• Maintain diaries for follow-up and ensure timely 24-hour contacts.
• Determine treatment appropriateness and causally relate to injury.
• Redirect treatment to network physicians as appropriate
• Refer subrogation or permanency concerns to supervisor.
• Work to ensure compliance with jurisdictional requirements for Medical Only claims.

Skills

Claims handling

Medical terminology

Attention to detail

Organizational skills

Verbal communication

Written communication

Independent work

Remote work

Education

High school diploma

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