The Claims Technician will investigate and manage workers compensation medical only claims and assist examiners in processing workers compensation claims to facilitate prompt and efficient claim handling and processing.The Claims Technician will investigate medical only claims to determine compensability in accordance with applicable statute, case law and experience. Monitor and document medical treatment to track progression of injured workers recovery and ensure treatment is appropriate; review medical records and approve medical treatment and expenses. Conduct compensability analysis; initiate and monitor medical benefits to ensure treatment is paid accurately. Communicate with internal/external customers to provide quality customer service, create understanding of the claims process and project a positive corporate image. Calculate reserves to accurately project cost of claim in accordance with established department policies. Maintain accurate and detailed documentation of claims to facilitate data management. Utilize Claims Processing and outsourced staff to assist and enhance efficiency of daily work. Review qualified expenses and promptly issue reimbursements to injured workers, policyholders or provider for covered services; obtains additional information from providers, as needed, to process claim. Provide clerical support to examiners in managing the flow of information into and out of the unit; generate correspondence as directed, schedule appointments, copy medical records and answer the telephone. Perform other duties as requested.
Bachelors Degree and experience in a medical or insurance setting preferred. Excellent organizational, interpersonal, written and verbal communication skills required. Strong computer skills and ability to learn custom software programs required.Kentucky Employers' Mutual Insurance (KEMI) is the largest provider of workers' compensation insurance in Kentucky. KEMI has been rated A- (Excellent) by A.M. Best for the tenth consecutive year for financial strength. KEMI was named one of the five Best Places to Work in Kentucky for 2011, was the first place winner in the 2010 Best Places to Work in Insurance competition amongst other small-sized property and casualty insurers from across the nation, honored with the Alfred P. Sloan Award for Workplace Flexibility, and was the winner of the We Care Award for Community Service. KEMI offers a progressive work environment that encourages teamwork and creativity as well as a competitive salary and benefits package. Qualified candidates should apply online at https://hrplex.kemi.com/job/jbJob.aspx and refer to Job ID 11311.
CareerBuilder - 10 months ago
- save job
-
block
