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Form a partnership with the medical case manager to maximize early return to work potential thereby reducing the need for extended disability payments, vocational rehabilitation, and other protracted claims costs.
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Requires a high degree of claims handling expertise to include a minimum of at least five years experience managing indemnity cases, many with complex or high potential subrogation, rehabilitation, medical management, and/or legal issues & possess an SIP certificate.
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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. Initiate the referral to the SIU of cases with suspected fraud.
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Review all medical bills for appropriateness prior to referral to InterMed for payment and posting to the claim file. Thoroughly and accurately document ongoing case facts and relevant information necessary for establishing compensability, the need for disability payments, the use of vendors, medical and expense payments, and what is being done to move the case toward closure.
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Reports directly to the unit Claims Supervisor and may be called upon to provide technical backup in the absence of the Claims Supervisor. In accordance with applicable statutes and in keeping with company rules, regulations, and established performance objectives, is responsible for effectively managing to conclusion an assigned inventory of claim files that may include cases of extreme complexity or with unique or unusual issues.
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Assure that all assigned indemnity claims have an up to date plan of action outlining activities and actions anticipated for ultimately resolving the claim. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
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Active study for the IEA Certificate and Self-Insured Certificate, and successful completion of, or active study for the WCCP designation, or the equivalent in related studies or work experience.
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Perform a three-point contact on all new losses within 24 hours of receipt of the claim to include the claimant, employer, and treating physician to document relevant facts surrounding the incident itself as well as disability and treatment status.
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To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. Respond to telephone messages and inquiries within 24 hours of receipt and to written inquiries within one week of receipt.
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May oversee and evaluate the work of student workers employed to assist in the institutional research effort and/or temporary employees or consultants employed to assist with speci.
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Litigation management - Direct, manage, and control the litigation process. Aggressively pursue subrogation from culpable third parties, contributions on multiple defendant cases, and apportionment when there is pre-existing disability.
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This complex work benefits from a nursing approach that is focused on creative problem solving and big-picture awareness rather than short-term solutions and reliance on strict rubrics. At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone.
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The claim involves moderate to complex litigation issues IW has returned to work, reached Maximum Medical Improvement (MMI), and has PPD. File litigated to dispute the permanency rating and/or causality.
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Work closely with Operations and Engineering teams to accomplish tasks to support processor workers and tissue processors. Ability to effectively work and interact with all members of the laboratory, tissue processing, research & development, and tissue recovery functions.
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This person will be responsible for handling moderate to complex California Workers' Compensation claims from inception to close. Handle mid to complex California Workers Compensation Lost Time claims.
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workers complex to work jobs
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