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Senior Workers' Compensation Claims… at Liberty Mutual · Rocklin
Skills
Job Description
Are you looking for an opportunity to join a claims team with a fast-growing company that has consistently outpaced the industry in year over year growth? Liberty Mutual Insurance has an excellent claims opportunity available for a Workers Compensation Claims Technician (Medical Only). Claims Technicians obtain essential information to process routine workers' compensation (WC) claims with on-going medical management for medical pension claims. Provides injured workers and customers with accurate, timely information and quality service. Claims Technicians also identify potential problems and make claim referral decisions.
*This position may be filled as a Workers Compensation Claims Technician or Workers Compensation Senior Claims Technician. Title and pay commensurate with experience.
GRS North America Claims is excited to announce our go forward strategy to provide employees with the flexibility to include an option to work from home full-time. Candidates who are selected for this position will be trained remotely.
Those in Las Vegas, NV; Chandler, AZ; or Lake Oswego, OR area may have an in-office requirement of 2 days per month. For those in the California or Washington area, this will be a fully remote position due to lack of a local office.
Responsibilities:
- Conduct investigation to secure essential facts from injured workers, employers and providers regarding workers' compensations through telephone or written reports.
- Verifies information from claimants, physicians, and medical providers to assess compensability and/or causal relation of medical treatment and make evaluations for cases with claim specific on-going medical management.
- Provides on-going medical case management for assigned claims.
- Initiates calls to injured workers and medical providers if projected disability exceeds maximum triage model projection or to resolve medical treatment issues as needed.
- Maintains contact with injured workers, providers and employers to ensure understanding of protocols and claims processing and medical treatment.
- Continually assesses claim status to determine if problem cases or those exceeding protocols should be referred to Claims Service Team and/or would benefit from, MP RN review or other medical /claims resources.
- Arrange Independent Medical Exam and Peer Review as necessary.
- Maintains accurate records and handles administrative responsibilities associated with processing and payment of claims.
- Records and updates status notes; documents result of contacts, relevant medical reports, and duration information per file posting standards including making appropriate medical information viewable to customers in Electronic Document Management (EDM).
- Generates form letters following set guidelines (i.e., letters to physicians projecting disability, letters confirming medical treatment and disability and letters outlining expected outcome to employers).
- Authorizes payment of medical payments and/or medical treatment.
- Recognizes potential subrogation cases, prepares cases for subrogation and refers these cases to the Subrogation Units.
- High school diploma plus 1-3 years of related customer service experience or applicable insurance knowledge.
- Licensing required in some states.
- Effective analytical skills required to learn and apply basic policy/contract coverage and recognize questionable coverage/contract situations (which necessitate supervisory involvement) along with effective interpersonal skills to explain the facts and logic used to arrive at decisions in a way that the customer understands.
- Effective written skills to compose clear, succinct descriptions when posting files and drafting correspondence.
- Good telephone and typing skills required.
- Ability to learn when to make proper use of medical management resources, know when to use them and follow through with medical management information received.
Pay Philosophy: The typical starting salary range for this role is determined by a number of factors including skills, experience, education, certifications and location. The full salary range for this role reflects the competitive labor market value for all employees in these positions across the national market and provides an opportunity to progress as employees grow and develop within the role. Some roles at Liberty Mutual have a corresponding compensation plan which may include commission and/or bonus earnings at rates that vary based on multiple factors set forth in the compensation plan for the role.
At Liberty Mutual, our goal is to create a workplace where everyone feels valued, supported, and can thrive. We build an environment that welcomes a wide range of perspectives and experiences, with inclusion embedded in every aspect of our culture and reflected in everyday interactions. This comes to life through comprehensive benefits, workplace flexibility, professional development opportunities, and a host of opportunities provided through our Employee Resource Groups. Each employee plays a role in creating our inclusive culture, which supports every individual to do their best work. Together, we cultivate a community where everyone can make a meaningful impact for our business, our customers, and the communities we serve.
We value your hard work, integrity and commitment to make things better, and we put people first by offering you benefits that support your life and well-being. To learn more about our benefit offerings please visit: https://www.libertymutualgroup.com/about-lm/careers/benefits
Liberty Mutual is an equal opportunity employer. We will not tolerate discrimination on the basis of race, color, national origin, sex, sexual orientation, gender identity, religion, age, disability, veteran's status, pregnancy, genetic information or on any basis prohibited by federal, state or local law.
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