York Risk Services Future Medical Claims Examiner in Pasadena, California
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.
- 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
- 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 of claims handling and settlement procedures in the California Workers’ Compensation system.
- Familiar with Microsoft applications such as Outlook and Microsoft Word. Required Experience
- 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.
- 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