Responsible for assisting Claims Department personnel with medical related issues on their claims.
At Safety National, we live by the following five core values: Relationships, Integrity, Teamwork, Balance, and Stability. Our Core Values serve as the fundamental foundation of our corporate culture and drive our interactions, both internally and externally. An essential function of all Safety National positions is to fully embrace and represent these core values in our daily work life and relationships.
Responsible for the medical management and oversight of high risk developmental (HRD) and catastrophic claims.
Assist Claims Analysts with medical management issues on assigned claims to include:
Communicate directly with self-administered account or TPA regarding claim medical management status
Direct and advise TPA and Field Nurse Case Manager as to desired claim handling
Document claim file as necessary regarding medical management activity
Refer claims to Best Doctors and other vendor partners for intervention
Travel on an “as needed” basis for TPA, Client and Broker meetings and presentations, seminars and conferences
Assist with ongoing training and in-service for Claims Department
Identify opportunities for ongoing training and information for claims team related to medical issues.
Assist as resource for Claims Analysts with medical information
Assist with Best Doctors partnership:
Assist with Best Doctor referral process
Discuss the Best Doctor’s program and benefits to TPA or Self-Administered Adjusters and clients regarding possible referral of a claim.
Participate in Best Doctor’s calls and document in claim file as needed.
Ensure all assigned claims are noted in Best Doctors report log.
Special projects and assistance as required by the Senior Vice President – Claims
Education: RN, BSN
Minimum 10years nursing experience (ER, OR, ICU, or Rehab, etc)
Workers Comp Nurse Case Management experience, minimum 5years.
Excellent written and oral communication skills.
Ability to communicate technical medical information to non-medical audiences.
Computer skills including Microsoft Word, Excel, Outlook and Internet search.
Must be able to think fast, and work in multiple task environment
Highly organized, maintaining large case assignment
Strong sense of customer service.
Professional appearance and attitude