Duties & Responsibilities: GENERAL DESCRIPTION:|
Under general supervision, reviews claims information and determines compensability of medical Workers' Compensation claims, or reimbursement liability of indemnity and medical payments claims made by employers and insurers on Workers Compensation cases accepted by the Subsequent Injury Trust fund. Authorizes disbursement of payments according to the Workers' Compensation and/or Subsequent Injury Trust Fund laws of Georgia and associated rules and regulations. Reviews claim payments. May assist a Workers' Compensation Specialist with processing of routine uncontested disability claims. Provides technical support to agencies, insurers, 3rd party Administrators and self-insured employers on the policies and procedures used when filing a claim.
1. Processes First Reports of Injury claims from state agencies, insurers, county health departments, 3rd party Administrators and self-employed insurers.
2. Processes Reimbursement Request Forms and determines reimbursement liability.
3. Provides authorization/denial on payment of medical bills based on medical necessity and monitors bill payment(s) based on established guidelines.
4. Provides technical support to agencies, insurers, 3rd party Administrators and self-insured employers on the policies and procedures used when filing a claim.
5. Maintains a consistent, high-quality, customer-focused orientation when conducting business and providing services or products to clients, the general public and other external customers.
Minimum Training & Experience: Completion of a High school diploma or GED and three years of job related experience OR One year experience at the lower level or position equivalent (FIT041) OR Completion of an Associate degree and two years of related experience
Agency Specific Qualifications and/or Preferred Qualifications: Experience in the authorization of workers' compensation claims payments
Additional Information: Due to the volume of applications received, we are unable to provide information on application status by phone or e-mail. All qualified applicants will be considered, but may not necessarily receive an interview. Selected applicants will be contacted by the hiring agency for next steps in the selection process. Applicants who are not selected will not receive notification.
This position is subject to close at any time once a satisfactory applicant pool has been identified.
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