Claims Team Lead

BCForward is currently looking for Care Manager II (RN) in Remote for CA.

Job Title : Claims Team Lead

Location : CA ( Remote )

Pay-Rate : $ 47 / Hr. on W2

County of Los Angeles experience preferred

Hybrid 2 days in office (flexible)

10 years of

experience in workers compensation. Self insurance certificate mandatory.

Job Description :

Maintain contact with team via Microsoft Teams and phone calls for teambuilding and to provide assistance

Approve overlimit payments process according to procedure

Review and approve new claim determinations and provide initial directions as to whether to delay, deny, accept

Review and approve litigation referrals and investigation referrals

Review mail of your team, provide direction as needed

Monitor for hearing dates and need for settlement authority requests or staffing of legal issues as they arise with examiner, DA, Director (if needed), County Representative (if needed)

Ensure team meets their monthly #s for core duties (reports are sent to assist with this)

Review and ensure Medata suspended payments (bill review payments pending approval by examiner) are reviewed / processed by examiners

Review and approve benefit notices prepared by examiners to ensure accuracy prior to mailing

Review and approve benefits payments that exceed examiners level and ensure appropriate documentation and paperwork is attached to the claim to support payment

Ensure claim coding is accurate and required fields are updated

Respond to email inquiries and phone calls to assist our customers

Review claims for supervisor direction every 90 days or sooner depending on need

Maintain diary on all claims with emphasis on lost time claims / and delays

Qualifications :

County of Los Angeles experience preferredHybrid 2 days in office (flexible)10 years of experience in workers compensation.

Self insurance certificate mandatory. Job Description : Maintain contact with team via Microsoft Teams and phone calls for teambuilding and to provide assistanceApprove overlimit payments process according to procedureReview and approve new claim determinations and provide initial directions as to whether to delay, deny, acceptReview and approve litigation referrals and investigation referralsReview mail of your team, provide direction as neededMonitor for hearing dates and need for settlement authority requests or staffing of legal issues as they arise with examiner, DA, Director (if needed), County Representative (if needed)Ensure team meets their monthly #s for core duties (reports are sent to assist with this)Review and ensure Medata suspended payments (bill review payments pending approval by examiner) are reviewed / processed by examinersReview and approve benefit notices prepared by examiners to ensure accuracy prior to mailingReview and approve benefits payments that exceed examiners level and ensure appropriate documentation and paperwork is attached to the claim to support paymentEnsure claim coding is accurate and required fields are updatedRespond to email inquiries and phone calls to assist our customersReview claims for supervisor direction every 90 days or sooner depending on needMaintain diary on all claims with emphasis on lost time claims / and delays.

Benefits :

BCforward offers all eligible employees a comprehensive benefits package including, but not limited to major medical, HSA, dental, vision, employer-provided group life, voluntary life insurance, short-term disability, long-term disability, and 401k.

About BCforward :

Founded in 1998 on the idea that industry leaders needed a professional service, and workforce management expert, to fuel the development and execution of core business and technology strategies, BCforward is a Black-owned firm providing unique solutions supporting value capture and digital product delivery needs for organizations around the world.

Headquartered in Indianapolis, IN with an Offshore Development Center in Hyderabad, India, BCforward's 6,000 consultants support more than 225 clients globally.

BCforward champions the power of human potential to help companies transform, accelerate, and scale. Guided by our core values of People-Centric, Optimism, Excellence, Diversity, and Accountability, our professionals have helped our clients achieve their strategic goals for more than 25 years.

Our strong culture and clear values have enabled BCforward to become a market leader and best in class place to work.

BCforward is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, or protected veteran status and will not be discriminated against based on disability.

To learn more about how BCforward collects and uses personal information as part of the recruiting process, view our Privacy Notice and CCPA Addendum.

As part of the recruitment process, we may ask for you to disclose and provide us with various categories of personal information, including identifiers, professional information, commercial information, education information, and other related information.

BCforward will only use this information to complete the recruitment process.

This posting is not an offer of employment. All applicants applying for positions in the United States must be legally authorized to work in the United States.

The submission of intentionally false or fraudulent information in response to this posting may render the applicant ineligible for the position.

Any subsequent offer of employment will be considered employment at-will regardless of the anticipated assignment duration.

Interested candidates please send resume in Word format Please reference job code 222087 when responding to this ad.

Get job alerts by email. Sign up now! Join Our Talent Network!

Salary Details

This salary was provided in the Job Posting.

Hourly Salary

Job Snapshot

Employee Type

Contractor

Location

California, US (Onsite)

Job Type

Health Care

Experience

Not Specified

Date Posted

05 / 03 / 2024