Provide guidance and establish workflows to prevent/avoid penalty exposure to include but not limited to self-imposed increase due to untimely periodic indemnity payments and awards, Administrative penalties as a result of failure to comply with the UR/IMR Process, LC 5814 penalty as a result of egregious claims actions, LC 5813 penalty due to frivolous and bad faith tactics and penalties/interest due to a late payment of medical benefits.
March 24, 2020
Initiate and/or implement process and procedural changes effectively to maintain productivity.
April 28, 2020
Review, assign and provide supervision of all claim activity for designated claims to ensure compliance with Corporate Claim Standards, client specific handling instructions and in accordance with applicable laws.
July 25, 2020
Supervises multiple teams of examiners, multiple product line examiners and/or several (minimum seven) technical operations colleagues for a wide span of control.
August 10, 2020
Leadership - Exhibits confidence in self and others.
August 19, 2020
Monitors Rx POS and OON reviews by nursing staff for accuracy and compliance with formulary, ODG, and WC State Guidelines as applicable.
September 06, 2020
Requires a working knowledge of the Labor Code of the State of California as it pertains to workers compensation claims and the legal requirements for handling them.
September 10, 2020
Maintains selected files on personal diary including all files reserved over $50,000, all subrogation files, all files with delayed or denied benefits, all files formally assigned to the SIU, and all files with unresolved coverage issues.
October 08, 2020
Makes recommendations to client as suggested by the claim status.
October 12, 2020
Performs quarterly audits of 10% of the open inventory of each claims specialist for the purpose of validating the accuracy and completeness of the claims management process as well as to identify opportunities for improving the process as well as the claim result.
October 20, 2020