Monitors status and quality of work performed. Refers appropriate files for task management assignments to approved vendors for medical management, special investigative needs, Conditional payments, etc.Manages all medical aspects of a claim file with a focus on RTW and end of treatment.Facilitate early RTW through temporary transitional alternate or modified work.Full understanding of Medicare reporting requirements as they relate to a Workers' Compensation claim.Coordinate medical treatment for injured workers and provide information to treating physician(s) regarding the employee's medical history, health issues and job requirements.Comply with carrier excess reporting and threshold requirements.Identify Subrogation potential and pursue the process for reimbursement.Establish and maintain proper reserving throughout the life of the claim.Prepare and issue notices in accordance with mandated requirements and regularly review and stay abreast of applicable laws, rules and regulations that may impact how claims are processed.Interacts with Disability and Leave Examiners' for the coordination of non occupational benefits.Interacts with Injured workers, client contacts and attending Physician(s) to ensure awareness and understanding of the Workers' Compensation process, requirements and entitlements.Interacts with various parties involved in the claims process.Exercise proper judgment and decision making skills to analyze claim exposure, determine a proper plan of action to appropriately mitigate and settle/close the claim.Processes claims consistent with clients' and corporate policies, procedures and "Best Practices" and in accordance with any statutory, regulatory and ethics requirements.Includes the investigation, evaluation and determination of coverage, compensability and responsibility and the setting of proper reserves. Position SummaryThe Claims Examiner, Workers Compensation (Medical Only) investigates, evaluates, and resolves non-disabling medical claims with limited complexity. Matrix is a friendly and pleasant office environment offering flexible schedules Monday-Friday. Matrix Absence Management offers a full benefit package - Medical, Dental & Vision, including 401K match. Our mobile app technology provides ease of use to our client and employee in reporting claim information. Our highly customer centric approach is to try and duplicate the culture of our clients to make the experience seamless for employees. We partner with our clients Human Resources department to manage Workers' Compensation, Disability and/or Leave of absences until the claim is resolved or the employee returns to work. Matrix Absence Management is one of the top Third Party Administrators (TPA) supporting clients in absence management (FMLA/Disability/Workers' Compensation).
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