CLAIMS ADJUSTER
The Frank Gates Service Company offers workers? compensation program management for state funded and self-insured employers. In business since 1946, Frank Gates provides expert claims administration, superior group rating savings, experienced staff and state-of-the-art claims management software.
Frank Gates offers a wide variety of benefits that include: Three-tiered Health plan, dental, vision, er and ee paid life insurance, 401k with a company match, immediate Paid Time Off and much more. We are headquartered in Dublin, Ohio and are searching for the following positions:
Position: Claims Adjusters
Department: Ohio Self-Insurance
Reports To: Unit Leader
Summary of Qualifications
Qualified candidates must possess a minimum of 1 year of workers? compensation claims management experience.A bachelor degree from an accredited college or university or an Associate in Claims (AIC) and/or an Associate in Risk Management (ARM) from the Insurance Institute of America (IIA) are a plus.
Job Summary
To assist the company and department in administering client?s workers? compensation programs in accordance with statutory and regulatory authorities, internal policy and procedures, clients specifications, and within FGSC best claim practice guidelines.
The Adjuster will acquire knowledge the BWC and Industrial Commissions of Ohio laws and rules, and account requirements to ensure that all contractual obligations are satisfied.
The Adjuster will be responsible for the day to day management of all claims assigned to the unit, and will comply will all policy and procedures, and work flow processes to ensure process efficiencies, statutory and regulatory, and contractual compliance.
Essential Functions
? Process new and existing claims in accordance with FGSC best claim practices, including but not limited to:
o Three point contact
o Initial Reserving
o Action planning
o Review for compensability;
o Documentation
? Verify and calculate full and average weekly wage and rates in accordance with BWC and IC rules and laws.
? Respond to all attorney and claimant request for information regarding the claim.
? Direct all litigation to appropriate responsible party
? At clients direction, send file documentation to company attorney
? Calculate and issue timely compensation payments, including: Temporary Total, Permanent Partial, Permanent Total, Wage Loss, Loss of Use, and Death awards.
? Actively review with client 14 days actives
? Actively utilize ?Things to Do? to schedule future actions on claims
? Timely and accurately complete system generated ?Things to Do? action items
? Review claims in accordance with case management criteria for referral to Nurse Case Management in accordance with client specifications, and monitor ongoing nurse case management.
? Manage and document all outside referrals to ensure objectives are met, including all vendor charges, nurse case management, attorney?s and legal, IME?s, investigations, and vocational rehabilitation.
? Review all incoming claims related correspondence and determine appropriate action in accordance with client specifications and rules and laws.
? Document all claims management decisions, telephone conversations, and documentation.
? Mail checks in accordance with client specifications
? Assign initial reserves, and review ongoing reserves to ensure probable exposure is established.
? Review incoming request for authorization of medical treatment and take appropriate actions.
? Review all medical fee bills and approve or deny. Send all fee bills to Fee Bill Adjudication for processing and payment.
? File all required correspondence, medical reports, FROI?s, and legal documentation with the BWC in timely manner.
? Identify claims for closure and settlement.
? Perform other related duties as assigned
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