Workers Compensation Claims Technician, Medical Only
About the position
Liberty Mutual Insurance is seeking a Workers Compensation Claims Technician (Medical Only) to join our dynamic claims team. This role is pivotal in processing routine workers' compensation claims, particularly those involving ongoing medical management for medical pension claims. As a Claims Technician, you will be responsible for obtaining essential information from injured workers, employers, and medical providers to ensure accurate and timely processing of claims. You will provide quality service to injured workers and customers, ensuring they receive the necessary support throughout the claims process. Additionally, you will identify potential problems and make informed claim referral decisions to enhance the efficiency of our claims handling process. In this position, you will conduct thorough investigations to secure essential facts regarding workers' compensation claims. This includes verifying information from claimants, physicians, and medical providers to assess the compensability and causal relationship of medical treatment. You will also be responsible for ongoing medical case management for assigned claims, initiating calls to injured workers and medical providers when projected disabilities exceed maximum triage model projections or to resolve any medical treatment issues that may arise. Maintaining contact with all parties involved is crucial to ensure a clear understanding of protocols and claims processing. Your role will also involve continually assessing claim statuses to determine if any cases require referral to the Claims Service Team or would benefit from additional medical review resources. You will arrange Independent Medical Exams and Peer Reviews as necessary, ensuring that all claims are handled with the utmost care and accuracy. Administrative responsibilities will include maintaining accurate records, updating status notes, and documenting relevant medical reports in accordance with our file posting standards. You will also be responsible for authorizing payments for medical treatments and recognizing potential subrogation cases, preparing them for referral to the Subrogation Units. This position offers the flexibility to work from home full-time, with the requirement to visit the office twice a month if you reside within 50 miles of designated office locations. Liberty Mutual is committed to providing a supportive and inclusive work environment, where employees can thrive and grow in their careers.
Responsibilities
Conduct investigation to secure essential facts from injured worker, employer, 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.
,
Provide ongoing medical case management for assigned claims.
,
Initiate calls to injured worker and medical provider if projected disability exceeds maximum triage model projection or to resolve medical treatment issues as needed.
,
Maintain contact with injured worker, provider, and employer 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 results of contacts, relevant medical reports, and duration information per file posting standards.
,
Generate form letters following set guidelines (i.e., letters to physicians projecting disability, letters confirming medical treatment and disability, and letters outlining expected outcomes 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.
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.
,
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 and follow through with medical management information received.
Nice-to-haves
Benefits
Flexible work-from-home options
,
Comprehensive health insurance
,
401(k) retirement plan with company match
,
Paid time off and holidays
,
Tuition reimbursement
,
Employee discounts
,
Professional development opportunities
Apply Job!