What are the responsibilities and job description for the Claims Adjuster - Lost Time position at Cobb County School District (CCSD)?
Primary Function:
Handles all activities on lost time claims which include claims investigation; calculates and issues all indemnity payments; reviews medical treatment plan submitted by medical providers; approves appropriate treatment; interacts frequently with injured workers and responds in a courteous manner; files all applicable forms with State Board of Workers Comp.
Requirements:
1. Educational Level: High School Diploma or GED required
2. Certification/License Required: None
3. Experience: 2 years of experience in claims processing
4. Physical Activities: Routine physical activities that are required to fulfill job responsibilities
5. Knowledge, Skills, & Abilities: Written and oral communication skills; computer technology; organization; critical analysis ability
Essential Duties:
1. Demonstrates prompt and regular attendance.
2. Claims investigations; manages lost time workers compensation claims; interviews injured employee, employee supervisor and medical providers; submit to depositions; testifies and attends Worker's Comp hearings, as needed; ongoing interactions with defense and claimants attorneys.
3. Completes WC-1, WC-2, WC-3, and WC-4 and other State Board forms in a timely manner to provide to State Board via mail and electronic filing on the State Board EDI system.
4. Assesses treatment plans from medical providers; authorize appropriate treatment, including scheduling IME's, FCE's, Physical therapy, Pharmacy and Home Health Care.
5. Calculates indemnity payments based on 13 week salary history, maintains payment schedule and issues weekly benefit to injured workers.
6. Reviews medical bills for appropriateness of treatment; applies Georgia fee schedule to medical bills and approves for payment.
7. Works on vendor selection for medical services and products, including the Panel of Physicians; negotiates best pricing on durable medical equipment, diagnostics, Physical Therapy, Pharmacy and Home Health Care.
8. Obtains and maintains CWCP certification; attends continuing education seminars, conferences and webinars.
9. Answers telephone and assists or routes calls to appropriate individuals; composes correspondence to attorneys, medical providers and claimants.
10. Performs other duties as assigned by appropriate administrator.
Job Type: Full-time
Pay: $50,956.00 - $77,972.00 per year
Benefits:
- Dental insurance
- Health insurance
- Vision insurance
Work Location: In person
Salary : $50,956 - $77,972
