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Workers Compensation Claims Associate (Trainee Program)

Company: York Risk Services Group
Location: Austin
Posted on: July 14, 2019

Job Description:

At York, we believe that an experience marked by expertise, consistency and compassion sets us apart. And we celebrate the diverse backgrounds and unique perspectives that allow us to stand apart from our competitors. That's why we are committed to recruiting, developing and retaining people who represent our values and who believe in our mission.

Job Description****Come join our Workers Compensation Trainee Program!!! No workers comp experience necessary. Perfect opportunity for anyone wanting to begin a career in Workers Compensation Insurance!!!!****JOB SUMMARY:

Under close supervision, investigates claims of lesser value or complexity to determine an injured worker's entitlement to Workers' Compensation benefits; Administers indemnity and medical benefits for valid Workers' Compensation claims; manages a caseload of claims from inception to closing or settlement; Completes formal training program for consideration of advancement to Claims Examiner position.

ESSENTIAL JOB RESPONSIBILITIES:


  • Participates in ongoing training sessions, both formal and informal, to include York requirements and state-specific statutory requirements
  • Completes 3-point contact on new claims within 24 hours in order to obtain information necessary to make a compensability decision on the claim
  • Establishes appropriate reserve levels based on financial exposure and updates reserves upon receipt of new information
  • Directs assistant to properly pay indemnity benefits and Awards. Issue state-mandated benefit notices within the required timeframes
  • Annotates, categorizes and addresses incoming mail on a daily basis
  • Responds to questions and requests from the client
  • Ensure claim files are properly documented
  • Maintains professional client relationships and provides superior customer service
  • Each Examiner Trainee must successfully complete all State mandated continuing education hours and must also obtain the necessary license or certification in accordance with State regulations.
  • Evening or weekend courses/seminars might be required in order to meet certification/licensing requirements.

    SUPERVISORY RESPONSIBILITIES:

    SUPERVISION RECEIVED:

    • This position reports to the Unit Manager

      SUPERVISION EXERCISED:

      • NA

        OPS RACI RESPONSIBILITIES:

        • Three-point Contact
        • Investigations
        • Denials
        • Reserving
        • Benefit Delivery
        • Resolution of claims
        • CMR Compliance
        • Diary Compliance
        • Excess Reporting Compliance
        • Closing Ratio/Inventory Reduction
        • Significant Claims Activities
        • Regular File Reviews
        • Statutory Requirements
        • Client Relations
        • Continuous Improvement
        • Client Training

          OPS RACI ACCOUNTABILITIES:

          • Penalties and E&O's

            QUALIFICATIONS:

            EDUCATION:

            • BS / BA or Equivalent Work Experience

              EXPERIENCE:

              • 0 to 2 years

                SKILLS/ABILITIES:

                • Ability to prioritize multiple tasks and meet deadlines
                • Excellent written and verbal skills
                • Excellent customer service skills
                • Good interpersonal skills
                • Ability to work in a team environment

                  KNOWLEDGE:

                  • Workers' Compensation law, policies and procedures preferred
                  • Medical and legal terminology preferred
                  • Integration with Medicare preferred

                    ROUTINE DECISIONS AND FORMAL POLICY SETTING:

                    Decisions routinely made include:

                    • Analyzes information gathered from all sources to determine whether to accept, delay or deny a claim.
                    • Analyzes medical reports to determine whether benefits are due and/or make settlement recommendations to the client.
                    • Determines when an activity check or sub rosa would be warranted based on red flags noted on the claim.

                      Policy setting:

                      • No formal responsibility; Policies associated with the job's purpose and essential responsibilities are set by others


                        Apply Now!

Keywords: York Risk Services Group, Austin , Workers Compensation Claims Associate (Trainee Program), Other , Austin, Texas

Click here to apply!

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