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#hiring Senior Claims Adjuster, Workers' Compensation, Acton, United States, fulltime #jobs #jobseekers #careers #Actonjobs #Californiajobs #InsuranceSuperannuation Apply: https://lnkd.in/dFj855MQ Who We Are Method Workers' Compensation is a portfolio of workers' comp companies with the same mission: minimizing the human and financial cost of workplace injuries. We mitigate workplace injuries and deliver exceptional healthcare outcomes for injured workers, expediting a return to work, preserving families' livelihoods, and enhancing employers' productivity. We maintain in-house expertise in claims management, medical bill review, underwriting, and loss prevention for high-hazard, high-mod, and mid-market risks. From submission to claim, we're there every step of the way, improving outcomes for everyone involved. Method currently operates in all states. What To Expect The Senior Claims Adjuster is primarily responsible for analyzing workers' compensation claims to determine the benefits due. This position may have some supervisory roles. This role is also responsible for ensuring the ongoing adjudication of claims within service expectations and company best practices pursuant to all state, legal, statutory, and regulatory bodies. This is a full-time, salaried exempt position with standard business hours of Monday through Friday from 8:00am to 5:00pm, with some flexibility at manager's discretion. What You'll Do With minimal supervision, investigate claims, including but not limited to reviewing the first report of injuries, medical records; contracts; contacting insureds, injured workers, medical providers, and other parties to determine compensability in a timely manner.Understands, analyzes, and applies policy components to evaluate coverage.Ensure compliance of claims handling requirements pursuant to all state, legal, statutory and regulatory bodies.Exercise discretion and independent judgment with respect to evaluating and managing claims, including determining reserve amounts and document rationale.Evaluate exposure of claims by reviewing medical records and claim facts to determine causal relatedness of medical conditions.Manage the medical treatment and return to work process throughout the life of the claim.Adhere to Method Best Practices, Method Claims Protocol, and Claims Handling Guidelines.Maintain appropriate claim file documentation and accurate claim coding.Communicate claim activity regularly to any relevant internal and external stakeholders, including injured workers, policyholders, medical providers, and carriers, when appropriate.Timely prepare state filings within the state statutory regulations.Calculate the average weekly wage and indemnity benefits owed.Ensure all benefits are paid timely and in accordance with jurisdictional requirements.Exercise accurate discernment and decision-making to analyze claims exposure and to plan and d

Think Twice Before You Say No to a Virtual Team Hesitant about hiring a virtual assistant (VA) from another time zone? I was too. Worries about their commitment and effectiveness? Been there. Let me share how hiring a VA changed my perspective. ⭐ Concerns about a VA's dedication are common. 🔎 Finding a VA's hidden value can be eye-opening. 🕒 Different time zones aren't always a problem. I decided to give it a try, and it paid off. My VA, costing just $12 an hour for a full 40-hour week, was a game changer. No extra costs like health insurance, but the commitment and quality of work is outstanding. He worked harder, cared more about my business, and treated customers better than I could've imagined. Ever hired a VA? Comment your thoughts! #VirtualAssistant #RemoteWork #Efficiency #SmartHiring #GlobalWorkforce #CostEffective #ProductivityBoost

#hiring Workers Compensation Coordinator Bilingual Preferred, Chicago, United States, fulltime #jobs #jobseekers #careers #Chicagojobs #Illinoisjobs #Administration Apply: https://lnkd.in/dTff8fxD Workers Compensation Coordinator Bilingual PreferredPosition Summary The Workers Comp Coordinator meets these objectives by making telephonic contact with the injured worker, the worker's supervisor, the treating physician, and the claims adjuster. The contact provides reassurances to the worker, answers questions, identifies concerns, sells the benefits of transitional duty and occupational doctors, and is the workers primary source of assistance. Essential Functions: Initiate contact with injured employee immediately upon notification of injury. Continue contact as needed-at least weekly. Explain workers' compensation, the insurance carrier's role, and the injury counselor's role. Facilitate communication on benefits questions. Assess the injured worker's understanding of their injury, treatment, and satisfaction with care. Listen to concerns-encourage employees to call with concerns/problems. Establish open communication/maintain trust. Contact physician after every visit. Obtain work restrictions. Reiterate to the physician and employee about the desire to return to work as soon as appropriate and possible. Determine employee's condition and treatment plan. Determine cases requiring medical case management involvement. Act as liaison between management, claims adjuster, and employee to support return-to-work

Technology is key in helping examiners manage their claims more efficiently. Injured employees are more likely to engage in their recovery when they feel that their employer and claims examiner cares and supports them. Claims are easier to manage, there is less litigation, injured employees recover faster, and claims are closed and settled sooner. Plethy’s mission is to help injured employees recover faster by assisting them with their prescribed home exercises and tailoring a personal care approach that addresses the whole person through our Recupe program. The majority of patient recovery occurs at home yet 80% spend minimal time performing their daily exercises as prescribed by their physical therapist. Our Recupe coaches take time to understand the injured employee’s mindset and psycho-social situation. We incorporate the prescribed exercises on to our platform and motivate and communicate based on an individual’s specific needs and personality type. We are achieving a high engagement and adherence rate resulting in happier employees, quicker recovery and return to work and life. Plethy is at the forefront of technology that is innovative and necessary to benefit all stakeholders and, most importantly, the injured employees we serve.

Authorization and Credentialing Specialist Remote or hybrid work, FT with benefits, 40K   Experience with multiple insurances, experience with CBH, Credible, Excel Must be detail oriented, motivated, reliable, a team player.  5 years Billing/TPL/Auth experience -Call commercial insurance payersand verify each client's insurancebenefits -Confirm commercial insurance eligibility and specific coverage details for clients, communicate benefit information to the parents/guardians, and discusses financial responsibilities -Identify and document each commercial payer's policy and procedures regarding coverage, prior authorizations, andsubmission process -Complete prior authorizationrequest forms as appropriate forauthorization requests in partnership with clinical partners -Confirm that the clinicaldocumentation received is whatis required by the plan. -Ensure prior authorizations aresubmitted on time accordinglyto company and payor guidelines -Follow up with commercial insurance payers to check status of previously submitted prior authorization -Enter all documents and clientinformation or responses regardingprior authorization into companysystems -Quick to respond and communicate any changes in client's prior authorization status to care operations, clinical, andpartnerships teams. -Review and confirm all currentday copayment were collecteddaily -Process Authorization/TPL form  -Check for retro coverage on existing services, resubmit as needed -Edit billing signed services and resubmit to Payers -Credentialing of company and MD, CRNP and Psychologists with insurances.  #hiring

#hiring Workers Compensation Coordinator Bilingual Preferred, Chicago, United States, fulltime #jobs #jobseekers #careers #Chicagojobs #Illinoisjobs #Administration Apply: https://lnkd.in/d6A5c4Pa Workers Compensation Coordinator Bilingual PreferredPosition Summary The Workers Comp Coordinator meets these objectives by making telephonic contact with the injured worker, the worker's supervisor, the treating physician, and the claims adjuster. The contact provides reassurances to the worker, answers questions, identifies concerns, sells the benefits of transitional duty and occupational doctors, and is the workers primary source of assistance. Essential Functions: Initiate contact with injured employee immediately upon notification of injury. Continue contact as needed-at least weekly. Explain workers' compensation, the insurance carrier's role, and the injury counselor's role. Facilitate communication on benefits questions. Assess the injured worker's understanding of their injury, treatment, and satisfaction with care. Listen to concerns-encourage employees to call with concerns/problems. Establish open communication/maintain trust. Contact physician after every visit. Obtain work restrictions. Reiterate to the physician and employee about the desire to return to work as soon as appropriate and possible. Determine employee's condition and treatment plan. Determine cases requiring medical case management involvement. Act as liaison between management, claims adjuster, and employee to support return-to-work

𝗜𝘀 𝗳𝗶𝗻𝗱𝗶𝗻𝗴 𝗲𝘅𝗽𝗲𝗿𝗶𝗲𝗻𝗰𝗲𝗱 𝘀𝘁𝗮𝗳𝗳 𝗽𝗿𝗲𝘃𝗲𝗻𝘁𝗶𝗻𝗴 𝘆𝗼𝘂𝗿 𝗶𝗻𝘀𝘂𝗿𝗮𝗻𝗰𝗲 𝗮𝗴𝗲𝗻𝗰𝘆 𝗳𝗿𝗼𝗺 𝗴𝗿𝗼𝘄𝗶𝗻𝗴 𝗶𝘁𝘀 𝗯𝗼𝗼𝗸 𝗼𝗳 𝗯𝘂𝘀𝗶𝗻𝗲𝘀𝘀? Due to labor shortages, insurance agency producers and CSRs are overburdened with service responsibilities instead of focusing on agency growth. Learn more about how to solve this problem with Invisible Hand virtual back office/agency support: https://ow.ly/pRbw50PEaIm or call 908.268.1482. #Insuranceagent #insurance #BPO #insuranceBPO #businessprocessoutsourcing #backofficesupport #workflowanalytics #claimsprocessing #hiring #backoffice #workflow #relyonihc #insurancebroker