1. Assist claim examiners in preparation of State mandated benefit notices and fact sheets. 2. Determine eligibility for disability benefits through contact with medical providers and HR and request wage information and calculate disability rates and request personnel records in response to litigation. 3. Determine benefit payments start and stop dates and evaluate payroll records to calculate the correct benefit amount and issue the correct notice letters. 4. Coordinate and schedule Medical and Medical Legal exam appointments and prepare and send appointment notices 5. Help coordinate compliance with Medical Provider Network and evaluate medical provider information to determine response to liens – creating the appropriate response in the objection letters. 6. Evaluate medical information to determine what is relevant and required in preparation of IMR evaluation response. 7. Prepare bill and lien objections letters and prepare and submit Panel QME requests to DWC Medical Unit 8. Complete DEU 100 & 101 forms and prepare and submit Utilization Review Referrals plus prepare records for submission to the state for IMR medical treatment determinations in disputed medical utilization issues. 9. Request medical and legal records and prepare litigation files and provide information to attorneys. 10. Complete Stipulations, C&R forms, and Rating Requests and prepare Proof of Service with supporting documentation. 11. Order supplies as necessary, responsible for Purchasing card (P card) and paperwork. 12. Assist clerical support staff in all clerical duties when needed, including processing/scanning daily mail, phone
Requirements
1. Requires basic knowledge of California workers Compensation laws and regulations including terminology, benefit provisions, notice requirements, WCAB forms, etc. 2. Requires strong verbal and written communication skills good interpersonal skills. 3. Must be detail oriented, well organized and dependable. 4. Must be able to work in fast paced environment and handle multiple tasks with tact and composure. 5. Must be willing to learn new work comp related procedures. 6. Must have completed or be able to attend training classes covering basic workers’ compensation, disability benefits and medical benefits 7. Will be required to attend training seminars and classes as necessary to be proficient and current regarding changes in workers’ compensation law and regulations. 8. Requires excellent customer service skills, strong analytical skills. 9. Requires written and verbal communication skills and good interpersonal skills.
