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Claims Representative I
Ref No.: 18-08424
Location: Liberty Lake, Washington
Must have skills:
1) At least 3 years of customer service experience
2) Proficient skills with Microsoft Office
3) Excellent desk management skills

Demonstrates a proficient understanding and use of the basic policy/contract coverages and is able to recognize questionable coverage/contract situations which necessitate supervisory involvement. The ability to handle the complete claims representative work system is required. Ability to understand medical records and determine causality and medical necessity.

1. Obtains information about accidents and injuries from customers and claimants through telephone and written reports. Reviews medical records, communicates with customers, claimants, physicians, medical providers and attorneys. Must secure medical record necessary to process claim.
2. Recognizes potential subrogation cases and refers these cases to the Centralized Subrogation Unit.
3. Reviews medical records and bills to verify claimed treatment is causally related to the accident and is reasonable and necessary given facts of the claim.
4. Uses internet and Client contracted vendors i.e. Mitchell, for evaluation of medical payments and treatment.
5. Processes Wage Claims, No-Fault and medical payment claims. Secures and reviews appropriate medical documentation to verify treatment and causal relationship.
6. Updates status notes, establishes target dates, communicates with others, and releases payments on the automated system within limit of authority.