The Case Management Coordinator assists Claims Professionals regarding the medical treatment of injured workers, monitors and manages the cost and quality of field case management services, provides medical information and training, and helps establish and improve panels and networks of medical providers.
- Coordinate with Utilization Review and Claims Professionals to help guide the medical treatment provided to injured workers.
- Provide information and advice to Claims Professionals regarding medical issues in their claims including causation, diagnosis, prognosis, the overall path of treatment, and future treatment and the cost of that treatment.
- Support Claims Professionals in accurately reserving claims and valuing them for settlement by providing information about the likelihood and cost of future medical services; and upon request participate in roundtable discussions regarding those valuations.
- Review claims that meet specified criteria for medical issues and provide appropriate referrals, guidance, intervention, and alerts to ensure those issues are handled appropriately.
- Participate in strategic planning meetings regarding major claims, providing guidance and advice on the medical issues in the claims.
- Support Claims Professionals in ensuring that field case managers are assigned in appropriate claims in a timely manner, are given clear assignments, perform their work effectively and efficiently, and are removed from claims when their services are no longer required.
- Review bills for field case management services and reports from field case managers in order to assess the appropriateness of billed charges and the quality of services provided.
- Upon request, prepare and present training to Claims staff on medical topics.
- Assess and record the quality of services provided by medical providers in order to help create high-quality provider panels and networks.
- Foster a positive and close working relationship with other Company staff, including the adjusting staff, utilization review, medical bill review, special investigations, legal, lien resolution, the call center, and client services.
- Maintain patient confidentiality and safeguard protected health information in accordance with state and federal laws and Company policies.
- Certification and Education: Bachelor of Science Nursing degree (BSN); or Registered Nursing degree (RN), or Associate Nursing degree - Licensed Practical Nurse (LPN) with an active license.
- Language Ability: Able to read, analyze, and interpret medical journals, statutes, regulations, medical reports, medical coding, medical bills, claim notes, claim data fields, financial reports, and legal documents. Able to respond to technical inquiries from Company employees, external sources, and regulatory or auditing entities.
- Math Ability: Able to calculate figures and amounts such as discounts, interest, proportions, percentages, sums, differences, products, and volumes.
- Reasoning Ability: Able to apply common sense understanding to carry out instructions furnished in written, oral, or diagram form. Able to deal with problems involving several concrete variables in standardized situations.
- Technical Skills: Knowledge of current recognized evidence based medicine guidelines, office operations, workflow analysis, and current technologies in telecommunications, data entry, and file management.
- Computer Skills: Knowledge of Microsoft Office software. Able to quickly master proprietary and vended software applications.
COMPREHENSIVE BENEFITS PACKAGE:
- Disability and AD&D
- Retirement & Savings Plan with 100% employer match up to 5% of salary
- Education Assistance Reimbursement
- Paid Vacation and Holidays
The Berkshire Hathaway Homestate Companies (BHHC) is a group of six insurance companies that are part of the Berkshire Hathaway Insurance Group, headquartered in Omaha, Nebraska. Our Workers Compensation Division provides premier workers compensation insurance coverage to employers across the country, with offices in San Francisco, San Diego, Pasadena, Omaha, St. Louis, Atlanta, and Dallas.
As a member of the Berkshire Hathaway insurance group, BHHC has earned an enviable record of success in the insurance industry that is supported by an A++ A.M. Best rating, the highest rating they award insurance carriers. Our corporate size enables our organization to react swiftly and effectively to opportunities in the insurance marketplace. At the same time, our financial strength provides our agents and insureds the security rarely available in a regional specialty carrier.
We value each individual and recognize that attracting and retaining high quality talent is essential to the success of our company. Our structure minimizes bureaucracy and creates an environment that encourages our employees to see the direct effects of their hard work throughout the company. Each division provides hands on training and maintains a small company feel, creating an atmosphere in which 'team players' thrive.
BHHC - 5 months ago