Personal Injury/ Workers Compensation Senior Specialist needed for established healthcare group.
If you are a seasoned claims professional with extensive experience in personal injury and workers compensation line of business, and you have a passion for delivering exceptional results and have a proven track record in growing a PI and WC program within a healthcare company, we invite you to apply.
Here is what you will do:
-Initiate prompt contact with all parties involved on PI/WC administrative end and with any clinical team members end to conduct thorough documentation and authorization for coverage of medical treatment to patients.
-Ability to read medical records and properly evaluate values in multiple jurisdictions to ensure proper reserve practices.
-Engage in negotiation with lien groups, legal representatives, and other involved parties to reach competitive fee schedules and contracts.
-Spearhead and manage other team members within department to create new processes and fiscal quarter growth within line of business.
-Maintain detailed and organized claim and attorney files, documenting all relevant information, communications, and decisions.
Ensure compliance with industry standards and best practices in claims handling.
-Demonstrate a commitment to delivering exceptional customer service by responding to inquiries, addressing concerns, and keeping all parties informed throughout the claims process.
-Ability to handle multiple responsibilities and be adept at conflict resolution while working in a team environment. Work well under pressure.
-Able to think strategically, solve problems, set priorities, make the necessary decisions to resolve complex/regular issues/claims
