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Worker's Compensation Subject Matter Expert

Company:
eData Services Phils., Inc.
Location:
Makati, National Capital Region, Philippines
Posted:
November 07, 2018

Description:

PRIMARY RESPONSIBILITIES :

Ensures timely processing of workers' compensation claims; evaluates accident reports to determine accuracy and completeness and to ensure adequate investigation; ensures compliance with applicable laws and regulations. Scheduling and routing of necessary notices, checking of liens on what is accepted injury, requesting of medical records, billing process competion of report, including RFA filings.

ESSENTIAL FUNCTIONS:

• Evaluates accident reports, ensuring the timely processing of medical bills and temporary total disability benefits; reviews medical reports, witness statements, department investigation results, and other documentation.

• Maintains subrogation records and files for those incidents involving third parties. Sends subrogation letters to third parties in an effort to obtain reimbursement of monies spent by the city for medical treatment, time loss, and awards and settlements paid; submits amounts paid for medical treatment and/or temporary total disability benefits to the State Attorney's Office in order to seek reimbursement in cases where criminal charges have been filed.

• Compiles facts and data regarding accident reports and filed cases.

• Reviews documentation to determine whether medical bills and temporary total disability benefits should be continued; authorizes payment of medical bills and temporary total disability benefits upon receipt of proper documentation.

• Reviews accident reports to identify patterns of injury and to determine whether unsafe conditions contributed to the accident; advises departments of trends in injuries and proper safety procedures that may result in reduction of injuries.

• Documents telephone conversations, witness statements, medical reports, accident investigation results, and payment of medical bills; prepares summaries of medical reports; ensures that state Industrial Commission forms are properly prepared and filed.

QUALIFICATIONS AND EXPERIENCE:

• Graduate of Nursing

• At least 3 years experience in medical claims analysis

• Working knowledge of the Workers' Compensation Act and other applicable state/federal statutes and regulations.

• Working knowledge of medical terminology, body systems, and/or impairments and their disabling effects.

• Ability to evaluate all medical and time-loss claims information to make determinations regarding payment of temporary total disability benefits and medical bills.

• Good judgment in interpreting medical facts presented by a physician and applying these facts in determining an individual's capacity to engage in gainful occupation.