Manage all aspects of professional liability claims from inception through resolution, including investigation, coverage determination, and litigation oversight. Communicate loss exposure, reserve recommendations, and settlement strategies to clients while maintaining accurate claim file documentation.
The medical case manager provides telephonic case management in a workers' compensation environment to coordinate quality treatment and facilitate return-to-work placement. They are responsible for assessing medical records, monitoring treatment plans, and maintaining regular communication with claimants, employers, and providers.
The medical case manager provides telephonic case management in a workers' compensation environment to facilitate quality treatment and return-to-work placement. Responsibilities include assessing medical records, coordinating care between claimants and providers, and monitoring treatment plans to ensure cost-effective outcomes.
The Utilization Review Nurse performs prospective, concurrent, and retrospective reviews to determine the medical necessity of requested care using evidence-based criteria. They also coordinate discharge planning and collaborate with the Case Management team to ensure appropriate follow-up and cost-effective healthcare delivery.
Investigates, evaluates, and resolves complex commercial automobile and general liability claims, including those in litigation. Provides temporary coverage for other examiners to prevent backlogs and ensure continuity of operations.
Manage all aspects of professional liability claims from inception through resolution, including investigation, coverage determination, and litigation oversight. Communicate settlement strategies and loss exposure analysis to clients while maintaining accurate claim file documentation.
The Claims Examiner investigates, evaluates, and resolves complex commercial automobile and general liability claims, including those in litigation. They serve in a float capacity to provide seamless coverage for permanent examiners during absences to ensure continuity and meet service level agreements.
The Claims Examiner III is responsible for managing all aspects of professional liability claims from inception through resolution, including investigation, coverage determination, and litigation oversight. They must effectively communicate loss exposure and settlement strategies to clients while maintaining accurate claim files and documentation.
Responsible for reviewing policy information to determine coverage and conducting efficient claim examinations for auto and general liability claims. Oversees investigative service providers and communicates settlement strategies to clients while maintaining accurate claim documentation.
Provide telephonic case management within a workers' compensation environment to coordinate cost-effective treatment and facilitate return-to-work placement. Responsibilities include conducting initial assessments, monitoring medical appointments, and negotiating treatment plans with physicians.
Oversee the performance of a case management team and implement best practices to achieve departmental goals. Manage daily operations, human resource functions, and ensure compliance with regulatory requirements and client expectations.
Provide administrative support to case management staff by setting up referrals in the system and routing incoming calls. Coordinate communication between providers, patients, and physicians to ensure accurate patient information and documentation.
Responsible for preparing and maintaining provider contracts and the contracts database system. Ensures all providers maintain active status by completing initial and subsequent credentialing packages in compliance with state regulations.
Responsible for the prompt review of policy information to determine coverage and conducting efficient investigations for Commercial Auto and General Liability claims. The role involves managing litigation, communicating settlement strategies to clients, and providing coverage for permanent examiners during absences.
