The Medical only Claims Examiner will administer Medical Only claims and manage routine benefits. Process all claims in accordance with Keenan’s policies and procedures.
AP Keenan, an AssuredPartners company, is a successful insurance brokerage and consulting firm meeting the insurance needs of hospitals, public entities and California school districts. AP Keenan specializes in providing consulting services in the areas of: employee benefits, workers' compensation, loss control, financial, and property & liability. We have seen continuous growth and success, and are positioned to lead the industry into the 21st century. Together, with AssuredPartners, we continue to grow at a rapid pace, and so do the opportunities for our current and future employees.
Keenan is offering an exciting role as a Medical only Claims Examiner in the Workers' Compensation department. The MO Examiner will administer Medical Only claims and manage routine benefits. Process all claims in accordance with Keenan’s policies and procedures.
ESSENTIAL DUTIES AND RESPONSIBILITIES include the following:
- Perform data entry on all new medical only claims.
- Identify, prevent and mitigate potential penalties.
- Conduct 3-point contact as needed to verify the mechanics of the injury, compensability and discharge.
- Review all DWC letters (initial notices).
- Input form letters (30 day closing letters when appropriate).
- Calculate and pay mileage and benefits.
- Verify lost time and waiting periods.
- Review and manage modified duty.
- Maintain current diary.
- Input basic notes relating to claim, status and treatment.
- Identify issues requiring conversion to Indemnity and include supporting documentation.
- Refer all x-rays and diagnostic services to PRIME for utilization review.
- Process medical bills daily to avoid penalty and interest.
- Update reserves no later than 30 days of receipt of information modifying the financial exposure of a claim.
- Handle the conversion of claims within 180 days of injury or over $5000 total incurred (upon Supervisor approval)
- Investigate all questionable claim circumstances and refer to the Examiner when needed
- Maintain a 100% closing ratio.
- Return phone calls within 24 hours.
- Review mail / bills daily – paperless system.
- Correct error report daily.
- Maintain client/claimant satisfaction.
- Other duties as assigned.
MINIMUM SUGGESTED QUALIFICATIONS:
- Minimum of two (2) years of experience as a Claims Assistant experience preferred.
- Ability to multitask, communicate effectively, in writing and verbally, within all aspects of job requirements.
- IEA class course completion, preferred.
SOFTWARE: Proficient in Microsoft Outlook, Excel, PowerPoint and Word. Adept at accessing business data from the Internet when required.
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