York Risk Services Future Medical Claims Examiner in Pasadena, California

Job Description

The Future Medical Claims Examiner manages the medical care in accordance with the Award once a claim is settled, transferring the files to the Future Medical desk along with timely closing of files results in adherence to maximum caseloads of 150.

ESSENTIAL FUNCTIONS:

  • Monitor treatment in accordance with settlement and UR (35%).
  • Payment of benefits where applicable (Life pension, PD, medical bills and medical mileage reimbursement) (15%)
  • Diary compliance (new mail & CMR’s), verify, analyze and appropriately establish reserves based on lifetime exposure. (40%)
  • Excess reporting and request for reimbursement where applicable.
  • Provide verbal and written communication with our injured workers and clients.
  • Adherence to client protocls as well as York operating definitions Required Skills

SKILLS/ABILITIES:

  • Strong technical skills.
  • Good human relation skills, including the ability to work in conjunction with other administrative, management, and supervisory employees.
  • Ability to anticipate and resolve issues proactively and in a professional manner.

KNOWLEDGE:

  • Knowledge of claims handling and settlement procedures in the California Workers’ Compensation system.
  • Familiar with Microsoft applications such as Outlook and Microsoft Word. Required Experience

EDUCATION:

  • BS / BA or Equivalent Work Experience
  • Workers Compensation Examiner Certification required.

  • SIP Certification preferred; If the candidate does not have SIP they will need to obtain within 1 year from DOH.

EXPERIENCE:

  • Prefer 5 years Claims Examiner experience; WCCA/WCCP may substitute for 2 years experience.

Tracking Code: PASADENA06131701

Job Location: Pasadena, California, United States

Position Type: Full-Time/Regular