Quality Control Reviewer IV

Responsibilities

• ·        Responsible for managing, researching and analyzing various complex documents (Records Request; Subpoenas, Accident Questionnaires; Workers’ Compensation and No -Fault forms etc.) to determine whether a lien should be asserted

• ·        Interview members/patients, etc., review police reports, examine claims, and communicate with parties and stakeholders (carriers, attorneys, medical providers) to establish lien

• ·        Optimize work processes while responding timely to verbal and written communications for lien information via mail, fax and/or email from members and attorneys

• ·        Assist at the weekly workers’ compensation clinic by collaboratively communicating with attorneys and other departments within the Fund

• ·        Assist member walk-ins with inquiries regarding workers’ compensation & liens, as appropriate

• ·        Aid with departmental training needs as necessary which includes side by side mentoring of staff, collaborates with team and acts as subject matter expert (SME)

• Inbound and outbound communications (e.g. telephone calls, emails, faxes, letters, etc.) with attorneys, members, insurance carriers and other stakeholders regarding the Fund’s lien or general questions concerning the Fund’s rights to recovery, third party, workers’ compensation and no fault to educate member on Fund rights to recovery and reimbursement

• ·        Responsible for obtaining status of outstanding liens by contacting stakeholders and/or researching Elaw, ECourts, Ecase and other relevant external websites

• ·        Maintain status on assigned lien files by ensuring timely updates and reviews

• ·        Audit work of Chief Clerks and Quality Control Reviewers for accuracy and completion

• ·        Complete refund records and enter incoming check information into Perfect Law database

• ·        Enter lien information into Fund’s V3 and QNXT systems and Perfect Law

• Collaborate with department leadership to resolve complex issues, and disputes regarding right to recovery, causation, and lien negotiations.

• ·        Follow-up on disability and hospital/medical claims to ensure they are processed in a timely manner

• ·        Verify completion of files by reviewing for accuracy and required signatures per notary requirements

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