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Triage Researcher

CLAIM YOUR FUTURE AS A GREAT PERFORMER!
Continuing double-digit revenue growth rates and progressive employment practices make Sedgwick Claims Management Services the place where great people can do great things for clients while maximizing their career possibilities. We have earned a reputation for innovation, quality, sustained growth, financial stability and a colleague-friendly work environment. We are proud to have been voted the Best TPA in America for 2005 and 2006, and the first and only Third Party Administrator to receive the coveted Employer of Choice designation. Come be a part of our team and "Claim Your Future."

PRIMARY PURPOSE:
To provide initial research/data collection on new workers compensation (WC) claims; to assist in prompt and accurate reporting of required and situational claim data elements to the Bureau of Workers Compensation (BWC) via electronic data transmission; and to receive, review and research new claim EDI transmission from BWC.

ESSENTIAL FUNCTIONS and RESPONSIBILITIES
Receives notices of new claims via telephone, BWC-EDA-148 transmissions, or first report of injury (FROI) through FROI form, C-9, and other documentation; and receives, reviews and researches FROI reports to obtain required and situational data elements to facilitate initial EDI to BWC.
Receives, reviews and researches new EDI transmissions from BWC to identify case acuity level and refers to disability management per CHS policy; initiates first EDI on new claim within four (4) calendar days.
Communicates with service provider, injured worker and employer to obtain accurate data elements for evaluation and identification of acuity level.
Identifies appropriate staff to facilitate prompt assignment of new claims.
Identifies barriers to a return-to-work (RTW) status as they relate to the functional requirements of the injured worker's job duties.
Identifies appropriate referrals for Remain-at-Work and Vocational Rehabilitation Services; communicates this to assigned staff.
Educates employers to expedite early communications for FROI and RTW Services through CHS medical case management process.
Maintains current knowledge of BWC rules/laws, WC process and CHS policies and procedures.?

ADDITIONAL FUNCTIONS and RESPONSIBILITIES
Performs other duties as assigned.
Supports the organization's quality program(s).

QUALIFICATIONS
Education
High School diploma or GED required. Licenses as required.

Experience
One (1) year of general office experience required. Insurance industry experience preferred. Any college degree may substitute for the required experience.

Skills & Knowledge
Excellent oral and written communication skills
PC Literate, including Microsoft Office products
Analytical and interpretive skills
Strong organizational skills
Good interpersonal skills
Ability to provide accurate and prompt research
Ability to provide confirmation for identification of the Degree of Disability Management (DoDM)
Ability to work in a team environment
Ability to meet or exceed Performance Competencies

WORK ENVIRONMENT
When applicable and appropriate, consideration will be given to reasonable accommodations.

Mental: Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines

Physical: Computer keyboarding; travel as required

Auditory/Visual: Hearing, vision and talking

The statements contained in this document are intended to describe the general nature and level of work being performed by a colleague assigned to this description. They are not intended to constitute a comprehensive list of functions, duties, or local variances. Management retains the discretion to add or to change the duties of the position at any time.

Sedgwick CMS is an Equal Opportunity Employer
and a
Drug-Free Workplace

How to apply: DO NOT use the Apply Online button. Please copy and paste the following link into your browser address bar:
http://sedgwickcms.contacthr.com/20578019

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Published on Jul 22, 2011
Viewed: 303 times