Claims Technician, Worker's Compensation, Commercial Insurance
Advance your career at Liberty Mutual Insurance - A Fortune 100 Company!
Claims Technicians obtain essential information in order to process routine workers' compensation (WC) claims with typically up to twelve weeks of disability and/or on-going medical management for medical pension claims. Provides injured workers and customers with accurate, timely information and quality service. Claims Technicians also identity potential problems and makes claim referral decisions. This position is used in both the Short-term Duration Unit (SDU) and Medical Pension (MP) department.
1. Conducts investigation to secure essential facts from injured worker, employer and providers regarding workers' compensations through telephone or written reports. Verifies information from claimants, physicians, and medical providers to assess compensability and/or causal relation of medical treatment, and make evaluations for cases with typically up to twelve weeks disability and/or claim specific on-going medical management.
2. Provides on-going medical and/or disability case management for assigned claims. Initiates calls to injured worker and medical provider if projected disability exceeds maximum triage model projection or to resolve medical treatment issues as needed. Maintains contact with injured worker, provider and employer to ensure understanding of protocols and claims processing and/or to confirm return-to-work date or medical treatment.
3. Continually assesses claim status to determine if problem cases or those exceeding protocols should be referred to Claims Service Team and/or would benefit from, MP RN review or other medical /claims resources. Refers case to SDU/MP RN if light duty potential is identified at any point or for issues involving medical treatment or dispute involving disability or based on exception reports and defined departmental protocols. Arranges Independent Medical Exam and Peer Review as necessary.
4. Maintains accurate records and handles administrative responsibilities associated with processing and payment of claims. Records and updates status notes; documents results of contacts, relevant medical reports, and duration information per file posting standards including making appropriate medical information viewable to customers in Electronic Document Management (EDM). Generates form letters following set guidelines (i.e., letters to physicians projecting disability, letters confirming medical treatment and disability and letters outlining expected outcome to employers).
5. Authorizes payment of weekly benefits, medical payments and/or medical treatment
Effective analytical skills required to learn and apply basic policy/contract coverage and recognize questionable coverage/contract situations (which necessitate supervisory involvement) along with effective interpersonal skills to explain the facts and logic used to arrive at decisions in a way that the customer understands. Effective written skills to compose clear, succinct descriptions when posting files and drafting correspondence. Good telephone and typing skills required. Ability to learn when to make proper use of medical management resources, know when to use them and follow through with medical management information received. High school diploma plus 1 to 3 years of related customer service experience or applicable insurance knowledge. Licensing required in some states.
We value your hard work, integrity and commitment to positive change. In return for your service, its our privilege to offer you benefits and rewards that support your life and well-being. To learn more about our benefit offerings please visit: https://LMI.co/Benefits
At Liberty Mutual, we give motivated, accomplished professionals the opportunity to help us redefine what insurance means; to work for a global leader with a deep sense of humanity and a focus on improving and protecting everyday lives. We create an inspired, collaborative environment, where people can take ownership of their work; push breakthrough ideas; and feel confident that their contributions will be valued and their growth championed.
Were dedicated to doing the right thing for our employees, because we know that their fulfillment and success leads us to great places. Life. Happiness. Innovation. Impact. Advancement. Whatever their pursuit, talented people find their path at Liberty Mutual.