Senior Workers' Compensation Claims Technician

Liberty Mutual•Las Vegas, NV

2d•Remote

About The Position

Liberty Mutual Insurance is seeking a Workers' Compensation Claims Technician (Medical Only) to join their claims team. This role involves obtaining essential information to process routine workers' compensation claims with ongoing medical management for medical pension claims. The Claims Technician will provide injured workers and customers with accurate, timely information and quality service, and will 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, with title and pay commensurate with experience. The company is offering a go-forward strategy that includes the option to work from home full-time, with remote training provided. This position is open to Nevada-based candidates only. Candidates residing within 50 miles of Las Vegas, NV may be required to come onsite up to two days per month.

Requirements

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).
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.

Responsibilities

Conduct investigation to secure essential facts from injured workers, employers and providers regarding workers' compensations through telephone or written reports.
Verify 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.
Provide on-going medical case management for assigned claims.
Initiate calls to injured workers and medical providers if projected disability exceeds maximum triage model projection or to resolve medical treatment issues as needed.
Maintain contact with injured workers, providers and employers to ensure understanding of protocols and claims processing and medical treatment.
Continually assess 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.
Maintain accurate records and handle administrative responsibilities associated with processing and payment of claims.
Record and update status notes; document 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).
Generate 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).
Authorize payment of medical payments and/or medical treatment.
Recognize potential subrogation cases, prepare cases for subrogation and refer these cases to the Subrogation Units.