Investigate, evaluate, analyze, and determine compensability of time loss and catastrophic claims. Calculate average monthly wage and set reserves. Compute and authorize indemnity and medical benefits; update claims system; negotiate settlements, and notify the respective client loss prevention coordinator of risks.Monitor changes to diagnosis to verify ICD codes are current for Medicare purposes.Coordinate activities of nurse case managers, attorney and/or subrogation specialists, and with other RMD sections as appropriate.Identify the need for and coordinate Independent Medical Examinations (IMEs) Communicate with the client personnel and injured employees, conduct claims management training and claim review, as needed. Exercise independent judgment on complex claims and functions as directed.Proper management of litigation working with Attorney General's Office or outside counsel, experts, and plaintiff counsel. Oversee performance of contracted vendors and experts to assist in claim management, such as labor market consultants, nurse case anagers,investigators, and IME coordination services.
Required Skills
4+ Years of Claims Experience (Indemnity Experience)
Preferred Skills
AZ Adjustments License
Proficient in Google Suite
Notes:Remote
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