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- Maintain contact with team via Microsoft Teams and phone calls for teambuilding and to provide assistance
- Approve overlimit payments process according to procedure
- Review and approve new claim determinations and provide initial directions as to whether to delay, deny, accept
- Review and approve litigation referrals and investigation referrals
- Review mail of your team, provide direction as needed
- Monitor for hearing dates and need for settlement authority requests or staffing of legal issues as they arise with examiner, DA, Director (if needed), County Representative (if needed)
- Ensure team meets their monthly #'s for core duties (reports are sent to assist with this)
- Review and ensure Medata suspended payments (bill review payments pending approval by examiner) are reviewed/processed by examiners
- Review and approve benefit notices prepared by examiners to ensure accuracy prior to mailing
- Review and approve benefits payments that exceed examiner's level and ensure appropriate documentation and paperwork is attached to the claim to support payment
- Ensure claim coding is accurate and required fields are updated
- Respond to email inquiries and phone calls to assist our customers
- Review claims for supervisor direction every 90 days or sooner depending on need
- Maintain diary on all claims with emphasis on lost time claims/and delays
Claims Team Lead - San Francisco, United States - CMJobPoster
Description
Job Title: Claims Team Lead
Location (On-site, Remote, or Hybrid?): Ontario, CA (hybrid)
Contract Duration: Contract until 11/16/2024
Description:
County of Los Angeles experience preferred
10 years of experience in workers compensation. Self insurance certificate mandatory.
Job Description: