Provide Workers' Compensation (“WC”) claims adjusting in support of BIW's self-insured/self-administered WC program to include, but not limited to:
- Timely review of new claims for compensability determinations and processing qualified claimants in accordance with strict regulatory agency rules and regulations.
- Responsible for accurate and timely filing of State and Federally mandated forms in accordance with strict agency rules and regulations.
- Effectively and efficiently manage -book of claims by reviewing open claims at a regular cadence and documenting medical management with internal and external providers.
- Provide assistance and guidance to injured employees and providers.
- Review for reasonableness and approval of medical invoices in accordance with treatment plans.
- Identify opportunities for continuous process improvement and work closely with team members toward achieving same.
- Interact with State and Federal agencies to provide claim data and answer questions.
- Work closely with Medical Dept., Operations, Human Resources, Labor Relations, and other functional areas to promote early return to work.
- Evaluate claim exposure, establish case reserves, negotiate and resolve claims. Work closely with defense counsel on litigated claims to develop litigation plan. Attend mediation and hearings as necessary.
- Keep up to date on State and Federal laws as well as Medicare reporting requirements.
- Participate in the analysis of compliance reports and provide feedback as required.
- Assist in the process of internal and external financial and claim audits as required.
- Provide assistance and back up for internal and external reporting, including quarterly CMS (Centers for Medicare & Medicaid Services) reconciliation reports.
- Other administrative duties as assigned by the Director of Risk Management.