Claims Team Lead - Workers Compensation
Job Description :
Pay Range : $41hr - $46hr
- Maintain contact with team via Microsoft Teams and phone calls for teambuilding and to provide assistance.
- Approve overlimit payments process according to procedure.
- Review and approve new claim determinations and provide initial directions as to whether to delay, deny, accept.
- Review and approve litigation referrals and investigation referrals.
- Review mail of candidate team, provide direction as needed.
- Monitor for hearing dates and need for settlement authority requests or staffing of legal issues as they arise with examiner, DA, Director (if needed), County Representative (if needed).
- Ensure team meets their monthly #’s for core duties (reports are sent to assist with this).
- Review and ensure Medata suspended payments (bill review payments pending approval by examiner) are reviewed / processed by examiners.
- Review and approve benefit notices prepared by examiners to ensure accuracy prior to mailing.
- Review and approve benefits payments that exceed examiner’s level and ensure appropriate documentation and paperwork is attached to the claim to support payment.
- Ensure claim coding is accurate and required fields are updated.
- Respond to email inquiries and phone calls to assist our customers.
- Review claims for supervisor direction every 90 days or sooner depending on need.
- Maintain diary on all claims with emphasis on lost time claims / and delays.
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