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Self Insured Claims

Self Insured Workers' Compensation Claims Representative - Cincinnati, OH

BASIC FUNCTION

The Self Insured Claims Assistant is responsible for providing assistance to assigned Account Executives.

RESPONSIBILITIES

  • Create and mail a variety of claim related letters as directed by Account Executive
  • Printing/ mailing of all client checks and reports associated
  • Assist in IME scheduling, Case Management assignment, printing medical reports, mailing materials, etc.
  • Perform ISO online searches for clients and Account Executives
  • Assist in various clerical and support function
  • Assist with benchmarking spreadsheets for Account Executive caseload
  • Input of fee bills for payment processing
  • Review of medical records and medical bills for processing
  • Creating and sending all client reports on a monthly basis
  • Assist with Section 111 CMS reporting
  • Field inbound phone calls related to medical payments

JOB REQUIREMENTS

  • Positive attitude and team player mentality
  • Excellent oral and written communication skills
  • Computer skills and experience with Microsoft Word & Excel
  • Highly organized with an attention to detail

Self Insured Workers' Compensation Account Executive - Cincinnati or Dublin, OH

Job Description
We are currently seeking a Workers’ Compensation Self Insured Account Executive in our Cincinnati or Dublin, OH office, to serve as the single point of contact for an assigned client base.

Basic Function
Serve as the single point of contact for assigned Self Insured clients. Responsible for all phases of self insured workers’ compensation program including but not limited to aggressive claims management, general administration, and client relations. The SI Account Executive position requires special focus on risk management strategies and exceptional customer service.

Responsibilities

  • Assist and advise clients on all aspects of self insured workers’ compensation programs.
  • Provide aggressive claims management for all workers’ compensation claims.
  • Develop aggressive action plans that utilize best practice strategies to improve return-to-work and cost controls.
  • Coordinate referrals to partner entities for investigations, field case management, and other cost containment services.
  • Calculate and assign appropriate reserves to claims; monitor reserve adequacy for life of claim.
  • Communication with injured workers, employers, attorneys, and related medical providers.
  • Review all medical treatment requests (C9s), fee bills, and medical records for appropriateness.
  • Process fee bill payments, reductions and denials.
  • Ensure client self insured program is compliant with all state rules and regulations including filing of all required State forms, reports and data. Assist with and ensure SI-40 reporting (Ohio).
  • Regularly coordinate and attend client meetings for program review, strategies, and claim reserves.

Experience

  • Positive attitude, energetic, and team player mentality
  • Excellent oral and written communication skills
  • Ability to Effectively Prioritize
  • Workers’ Compensation Knowledge with a license and background in Kentucky

Self Insured Workers' Compensation Claims Representative - Cincinnati, OH

Department/Location

Self Insured

Basic Function

Serve as the single point of contact for assigned Self Insured clients. Responsible for all phases of self insured workers’ compensation program including but not limited to aggressive claims management, general administration, and client relations. The SI Account Executive position requires special focus on risk management strategies and exceptional customer service.

Responsibilities

  • Assist and advise clients on all aspects of self insured workers’ compensation programs.
  • Provide aggressive claims management for all workers’ compensation claims.
  • Develop aggressive action plans that utilize best practice strategies to improve return-to-work and cost controls.
  • Coordinate referrals to partner entities for investigations, field case mgt, and other cost containment services.
  • Calculate and assign appropriate reserves to claims; monitor reserve adequacy for life of claim.
  • Communication with injured workers, employers, attorneys, and related medical providers.
  • Review all medical treatment requests (C9s), fee bills, and medical records for appropriateness.
  • Process fee bill payments, reductions and denials.
  • Calculate payment of all compensation types, make timely payments, and issue claim/comp checks.
  • Prepare files for hearings of litigated issues.
  • Ensure client self insured program is compliant with all state rules and regulations including filing of all required State forms, reports and data. Assist with and ensure SI-40 reporting (Ohio).
  • Evaluate claim values for settlements and present to client. Negotiate to client approved level.
  • Attend client audits performed by the State.
  • Coordinate filing and reporting of 1099s to IRS.
  • Report, track and manage claims for submission to Excess carrier.
  • Regularly coordinate and attend client meetings for program review, strategies, and claim reserves.

Preferred Skills

Experience

A minimum of 3 years relevant experience and exposure to Ohio Workers’ Compensation.

Self Insured experience required.

The Matrix Companies is an entrepreneurial organization with unlimited growth potential. If you are passionate about performance, driving the profitability of a growing company and exceeding expectations at all times – Matrix is right for you!