The Worker’s Compensation Department is looking to add a Medical Only Examiner I to our Claims Triage team.Our Worker’s Compensation department provides innovative products and coverage solutions as well as professional and impartial claims handling. Join our team of skilled professionals that is dedicated to quality and superior customer service.
“Claim” your role. Our Medical Only Examiner I is a person who can represent the Worker’s Compensation Department as well as ICW Group. You are well organized, you can resolve conflicts fairly and equitably, you have excellent written and oral communication skills and customer service is a priority to you.
The Medical Only Examiner I will administer benefits in accordance with statutory and case law as well as pertinent regulations for an inventory comprised of minor injuries with no lost time. Reserves, manages and brings Workers’ Compensation claims to an equitable conclusion within the company standards and best practices guidelines. Maintains effective communications with other departments and maintains a good working relationship with customers. With limited direction, applies general principles, concepts and practices. Non-routine work and any work that exceeds financial authority is reviewed in progress. Requires review/approval of reserves up to $2,500.
• Moves inventory to closure or upgrades as injuries evolve. • Manages medical treatment to bring files to closure.
• Assesses reserves appropriately and timely with authority level not to exceed $2,500. • Pays bills appropriately and timely.
• Receives and reviews information related to Medical Only claims.
• Communicates via mail, phone and email with injured workers, employers and medical providers.
• Sets up file diaries, document follow-up care and other claim related activities. • Follows up with medical providers to obtain results.
• Supports the process by scheduling medical or testing appointments to determine appropriateness of medical care being received related to injury.
• Authorizes/certifies medical treatment in line with Utilization Review Regulations and as outlined within department UR plan.
• Reviews and respond to incoming mail, emails, telephone calls, and fax transmissions from providers and injured workers.
• Takes actions required to respond to mail.
• Reviews and approves or denies medical bills, and returns bills with insufficient information.
• Processes bills in the bill paying and tracking system or issues for processing by others. • Identifies, investigates, and pursues subrogation cases.
• Responsible for bringing files to supervisor’s attention when issues become complex.
- High school diploma or general education degree (GED)
- Must be Nevada state certified within 1 year of handling the Medical Only desk or certification along with 1-3 years insurance experience.
- Must have 1 to 3 years medical only claims handling experience or 1 year claims examining