- Review Employer's First Report of Injury (WC- 1) for accuracy and completion.
- Manage medical only, lost time and disfigurement claims. Assignments are based upon the assessment and determination of the Claims Manager.
- Complete 24-hour three-point contact to claimant, employer and physician. Secure formal statements from injured workers as deemed appropriate.
- Calculate average weekly wages and compensation rate. Issue timely indemnity benefits in compliance with Hawaii Revised Statutes (H.R.S.) 386.
- Identify any potential third party (subrogation).
- Process medical bills in compliance with Hawaii State Medical Fee Schedule and Claim Best Practices.
- Develop and implement claim strategies to facilitate case resolution. This may also include limited Triage and or TCM collaboration.
- Document and work within all Claims related systems to include but not limited to Guidewire, Image right, My Matrix (Express Scripts) and IQ Review (AMC Bills).
- Complete Reinsurance Reporting of financial exposures meeting the criteria ($250,000.00 and/or catastrophic).
- Establishes reserves based upon Probable Ultimate Cost.
- Attend hearings before the Director as deemed appropriate by Claim Management.
- Attend claim reviews on dedicated accounts as needed.
- Maintain current diary.
- Other duties as assigned.
- Current Hawaii Workers' Comp Adjuster's License preferred, but not required.
- Basic understanding of workers' compensation laws, rules, and regulations preferred. Medical and legal terminology a plus.
- Excellent customer service skills.
- Detail-oriented with high level of accuracy.
- Ability to maintain confidential information.
- Ability to work independently and collectively as a team.
- Excellent verbal and written communication skills.
- Proficiency in Microsoft Office applications preferred.
- Self-directed and flexible.
- Offer of employment contingent upon passing a state/federal background check and pre-employment drug test.
- Covid-19 vaccination required by client for this position. This is not an ALTRES Staffing requirement.
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claims specialist
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RPh on the Go Honolulu, United StatesJob Description · Job DescriptionMinimum 1+ years pharmacy experience required. · RPh on the Go is looking for a pharmacy technician to add to our claims specialist team in Aiea, HI. This is an 8-week temp to perm positionand were interviewing to start ASAP. Technician trainees a ...
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Entry-Level Claims Specialist - Honolulu, United States - ALTRES Staffing
Description
Entry-Level Claims Specialist (Workers' CompWork for a local insurance company, voted one of Hawaii's Best Places to Work
As the Workers' Comp Claims Specialist, you will manage workers' compensation claims for medical only, lost time, and disfigurement. A current Hawaii worker's comp adjuster's license and basic understanding of workers' compensation laws, rules, and regulations is highly preferred. Candidates for this role must also be able to work independently, and collectively as a team with a heavy focus on customer service.
Parking stipend available.
Hours
Full-time, Monday to Friday, 7:30am-4:30pm
Location
Honolulu, Oahu
Pay
$35,000 to $42,000 a year
