Medical Only Examiner - WC

Location

Rancho Cordova, CA | United States

Job description

Administer Medical Only claims and manage routine benefits. Process all claims in accordance with Keenan’s policies and procedures.

Keenan, an Accretive company, is an insurance brokerage and consulting firm meeting the insurance needs of hospitals, public entities and California school districts. Keenan specializes in providing consulting services in the areas of: employee benefits, workers' compensation, loss control, financial, and property & liability.

• Perform data entry on all new medical only claims.
• Identify, prevent and mitigate potential penalties.
• Conduct 3-point contact as needed to verify the mechanics of the injury, compensability and discharge.
• Review all DWC letters (initial notices).
• Input form letters (30 day closing letters when appropriate).
• Calculate and pay mileage and benefits.
• Verify lost time and waiting periods.
• Review and manage modified duty.
• Maintain current diary.
• Input basic notes relating to claim, status and treatment.
• Identify issues requiring conversion to Indemnity and include supporting documentation.
• Refer all x-rays and diagnostic services to PRIME for utilization review.
• Process medical bills daily to avoid penalty and interest.
• Update reserves no later than 30 days of receipt of information modifying the financial exposure of a claim.
• Handle the conversion of claims within 180 days of injury or over $5000 total incurred (upon Supervisor approval)
• Investigate all questionable claim circumstances and refer to the Examiner when needed
• Maintain a 100% closing ratio.
• Return phone calls within 24 hours.
• Review mail / bills daily – paperless system.
• Correct error report daily.
• Maintain client/claimant satisfaction.
• Other duties as assigned.

• Minimum of two (2) years of experience as a Claims Assistant experience preferred.
• Ability to multitask, communicate effectively, in writing and verbally, within all aspects of job requirements.
• IEA class course completion, preferred.
• Proficient in Microsoft Outlook, Excel, PowerPoint and Word. Adept at accessing business data from the Internet when required.

To help you make the best decision for your personal growth, it’s important to us to share a glimpse of what we offer our top asset, our people:   

• Competitive base salary.   
• Generous 30+ Days Comprehensive Paid Time Off Package inclusive of Paid Time Off, 10 Company Holidays, 2 Floating Holidays, 5 Sick Days, and 2 Volunteer Days.
• Health benefit options with you in mind; 5 affordable medical plan options with rates based on your salary, company paid HSA contribution with eligible HSA plan selection, 2 dental plan options offering orthodontia coverage and 3 cleanings per year, and 2 vision plan options.    
• Company match 401(k) plan – 50% up to 6%!   
• Support of your fitness wellness goals! We offer up to 75% off at over 11,000 gyms and fitness centers.    
• Opportunity to prioritize your mental health with 24/7 access to licensed therapists.   
• Pet benefits & discounts.    
• Access to our Employee-led Resource Groups (ERGs) that lend a voice to the variety of demographics represented throughout our company.

Compensation:

The target salary range for this position is $48,000.00 to $58,000.00 (US Dollar) annually. The actual salary will vary based on applicant’s education, experience, skills, and abilities, as well as internal equity and alignment with market data. The salary may also be adjusted based on applicant’s geographic location. Remote work environment flexibility.

Accretive is a collection of elite specialty and wholesale agencies supported by experienced industry leaders. Our expertise is broad, and our innovative culture runs deep. We value relationships above all else and consistently deliver best in class customized solutions and service you can trust.

Accretive  is passionate about fueling our clients’ innovation and growth. That makes us the perfect place for creative, dynamic people who want to grow their career while helping businesses, families and people thrive. We are proud to be one of the largest brokers in the country, but we’re even prouder of the honest, caring relationships that our employees build with our clients every day.

Working with us will give you the opportunity to do work that matters while you learn with us, advance with us, and most importantly, grow with us. Accretive is committed to embracing diversity, equity and inclusion to create a workplace that welcomes and thrives on the unique experiences, perspectives and contributions of all team members. Accretive is bringing the best people and most diverse talent forward to drive growth, innovate and think bigger! 

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