Claims Team Lead
Nesco Resource
- Ontario, CA
- $40.00-46.00 per hour
- Contract
- Full-time
County of Los Angeles experience preferred
Hybrid 2 days in office (flexible)
10 years of experience in workers compensation. Self insurance certificate mandatory.Job Description:
Maintain contact with team via Microsoft Teams and phone calls for teambuilding and to provide assistance
Approve overlimit payments process according to procedure
Review and approve new claim determinations and provide initial directions as to whether to delay, deny, accept
Review and approve litigation referrals and investigation referrals
Review mail of your team, provide direction as needed
Monitor for hearing dates and need for settlement authority requests or staffing of legal issues as they arise with examiner, DA, Director (if needed), County Representative (if needed)
Ensure team meets their monthly #'s for core duties (reports are sent to assist with this)
Review and ensure Medata suspended payments (bill review payments pending approval by examiner) are reviewed/processed by examiners
Review and approve benefit notices prepared by examiners to ensure accuracy prior to mailing
Review and approve benefits payments that exceed examiner's level and ensure appropriate documentation and paperwork is attached to the claim to support payment
Ensure claim coding is accurate and required fields are updated
Respond to email inquiries and phone calls to assist our customers
Review claims for supervisor direction every 90 days or sooner depending on need
Maintain diary on all claims with emphasis on lost time claims/and delaysNesco Resource provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state, or local laws.