Claims Adjuster, Lost Time (474B) [235]

POSITION TITLE:  Claims Adjuster, Lost Time

JOB CODE:  474B

DIVISION:  Human Resources

SALARY SCHEDULE:  Office Clerical/Technician Annual

DEPARTMENT:  Support Services

WORK DAYS:  Annual Administrative Employees

REPORTS TO:  Assistant Director, Risk Management

PAY GRADE:  Rank VII (NCT7)

FLSA:  Non-Exempt

PAY FREQUENCY:  Monthly

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.

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

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; authorizes 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.