Workers' Compensation Claims Manager jobs in Clearwater, FL

Description

The Work Comp Integrated Specialist is responsible for the coordination of referrals and authorizations from the insurance carrier, case management and/or employer in accordance to the company and state requirements while exhibiting excellent customer service.

Key Responsibilities:

• Marketing/maintaining relationships with referring adjusters/case managers.
• Register and update patient demographics and insurance information in the system.
• Schedule appointment(s) according to the patient need and physician's protocol.
• Obtain written authorization and required documentation for service(s) from the insurance carrier, adjuster or case manager and ensure authorization is documented in the system.
• Communicate with the patient advising of the scheduled appointment(s)
• Handle incoming adjuster/case manager calls and triage to the respective departments as needed.
• Send required documentation (DWC25 and notes) to the carrier and/or case management as instructed.
• Conduct a quality check on the internal document(s) prior to sending to the carrier and/or case management.
• Works with the insurance carriers, third party and our billing department to resolve payment and authorization issues.
• Serves as an internal point of contact for all departments involved.
• Identify improvement opportunities and provide solutions to management.
• Address internal and external email and fax correspondence as needed.
• Manage the Work Comp Dispensing (dispensing, inventory, ordering and charting)
• All other duties assigned

Qualifications

Qualifications

• High School Diploma or General Education Degree (GED)
• Required 2 years Florida and Federal Workers Compensation experience
• Requires comprehensive knowledge of computer skills including Microsoft Office Suite
• Excellent customer service and communication skills
• Knowledge of ICD10, CPT HCPCS, bill types and the use of modifiers
• Working Knowledge of medical terminology and human anatomy
• Recommended knowledge of Six Sigma process improvement tools and methodologies
• Must be detail oriented, handle multiple inquiries at a time, resourceful and a self-starter
• Adapt in a fast-paced working and team environment