Medical Only Claims Trainee

SUMMARY: (Brief 3-5 sentence paragraph outlining the main purpose of the job) 

This is an entry-level position. This position leads to a Medical Only Claims Specialist I and is expected to last up to 12 months. Upon completion of the training plan the incumbent is expected to be proficient with the Medical Only Claims policies, processes, procedures, and terminology related to the job. In addition, the incumbent will be proficient in the job responsibilities and tasks of the Medical Only Claims Specialist I position description. The incumbent will be evaluated on their progress and successful completion of the training plan each quarter. Upon satisfactory completion, the incumbent will be eligible for the Medical Only Claims Specialist I position.  Medical Only Claims Associate will work with all members of the team and may receive direction, support, and instruction from the Manager or Medical Only Claims Specialists depending on the assignment. 

ESSENTIAL DUTIES AND RESPONSIBILITIES include the following. Other duties may be assigned. 

1. Assist Medical Only Claims Specialist with the investigation and management of workers compensation claims. 

1. Assists with determining and managing the on-going medical treatment program including directing care, creating panels, and approving provider requests. 

1. Evaluates medical reports and correspondence for appropriate action/documentation. 

1. Supports the customer service work and processes for the multi-functional claims team; Communicates and collaborates with team members to ensure the appropriate and timely handling of claims in other states. 

1. May be required to act as a back up to the MOCS. For items such as Verifies workers’ compensation coverage of employers and injured employees. 

1. Documents specifics of claims with potential for subrogation.  

1. Approves payment based on knowledge of the treatment plan and medical support showing relationship of treatment to the injury. 

1. Concludes and closes files following resolution of claims to meet internal performance standards while complying with state legislation to avoid penalties and manage expenses. 

1. Coordinates with outside vendo