Claims Specialist - Workers Compensation Catastrophic Specialist
- Employer
- Georgia Administrative Services
- Location
- Lawrenceville, Georgia (US)
- Salary
- Not specified
- Posted
- Jul 16, 2018
- Closes
- Sep 14, 2018
- Category
- Claims, Workers' Compensation
- Job Type
- Full Time
- Career Level
- Experienced (Non-Manager)
The Workers’ Compensation Catastrophic Claims Specialist is responsible for quality handling of Georgia catastrophic designated and complex medical issues workers’ compensation claims in a timely, professional manner with emphasis on providing quality service while controlling expenses. Position routinely handles claims involving catastrophic designed injuries, complex injuries, complex medical issues and litigated workers’ compensation issues.
Responsibilities:
- Work with the catastrophically injured worker, his/her representative and the Catastrophic Rehabilitation Supplier to medically manage the claim. Review and evaluate on going medical information.
- Work with the Managed Care and Rehabilitation Division of the State Board of Workers’ Compensation to resolve issues related to catastrophically designated claims.
- Provide consistent customer service to State Agencies and injured workers through timely responses to all inquiries, telephone calls and emails while delivering on service commitments.
- Review incoming mail daily and process as needed.
- Maintain a current diary on outstanding claims.
- Evaluate and set reserves for ultimate exposure.
- Ensure accurate and timely entry of required data information in the claims system.
- File all required State Board forms timely.
- Provide required information and on-going communication with the excess carrier.
- Provide timely and appropriate responses to the Center for Medicare and Medicaid Services (CMS) payment/lien letters.
- Provide direction and guidance to defense attorneys and other experts while controlling costs.
- Meet or exceed specific objectives for service standards, quality, reserving standards, expense controls and other measurable performance items.
- Perform other duties as assigned.
Qualifications:
- Bachelor’s degree or equivalent work experience.
- 3-5 years’ experience handling catastrophic designated and/or complex medical issue claims.
- Excellent communication and negotiation skills.
- Strong verbal and written skills are required;
- The ability to multi-task and prioritize is needed; strong organization and time management skills required.
- Valid Georgia all lines adjuster license or the Georgia Certified Workers’ Compensation Professional designation.
- Knowledge of Georgia workers’ compensation law.
- Computer proficiency, working knowledge of Microsoft Office Products