Nurse - Claim Representative Workers’ Compensation position at Secura in Appleton

Secura is employing Nurse - Claim Representative Workers’ Compensation on Wed, 17 Apr 2013 03:19:02 GMT. Responsible for managing assigned claims to ensure claims are managed to our Best Practices, including receiving appropriate healthcare in order to return to work and normal activity in a timely and cost effective manner. Caseload may include catastrophic/complex medical/disability cases; lost time and/or medical only claims. This position is a combination of in-house telephonic medical case...

Nurse - Claim Representative Workers’ Compensation

Location: Appleton Wisconsin

Description: Secura is employing Nurse - Claim Representative Workers’ Compensation right now, this position will be placed in Wisconsin. For detail informations about this position opportunity please read the description below. Responsible for managing assigned claims to ensure claims are managed to our Best Practices, including receiving appropriate healthcare in order to r! eturn to work and normal activity in a timely and cost effective manner. Caseload may include catastrophic/complex medical/disability cases; lost time and/or medical only claims. This position is a combination of in-house telephonic medical case management and claims representative duties.Contact medical providers and injured workers on assigned lost time cases involving disability and significant medical treatment to determine medical needs.
Develop medical management strategy and give the providers information necessary to facilitate a return-to-work plan.
Suggest cost-effective treatment alternatives when appropriate and ensure that injured workers have aggressive treatment plans in place.
Authorize medical treatment and associated diagnostic testing on assigned claims.
Assist insured individuals in the development of aggressive return-to-work programs.
Where appropriate, channel injured workers to network providers.
Contact employer to initiate m! odified duty or full return-to-work and/or obtain job descript! ion and discuss job modifications required to ensure a prompt return to work.
Analyze, review, negotiate, and settle Workers’ Compensation claims of varying complexity, in a thorough manner and with minimal supervision.
Control legal and medical bills/records to ensure savings for the company.
Make contact with claimants within 24 hours on all lost-time claims.
Work effectively with doctors, attorneys, insureds, claimants, and associates.
Participate in prehearing settlement conferences.
Establish and monitor reserves to adequately reflect the exposure, and make appropriate changes as each file develops.
Uphold highest level of service orientation toward all customers.
Assist in agency management by providing feedback to Underwriting.

Qualifications:
Required:
Strong communication skills in order to effectively communicate with claimants, medical professionals, employees, claims staff, case management vendors ! and others.
Ability to analyze and make sound nursing judgments and to accurately document activities in the claims management system.
Good negotiation skills to effectively establish target return-to-work dates.
Knowledge of state, local and federal laws related to health care delivery.
Personal computer knowledge and proficiency.

Preferred:
Must have current registered nurse [R.N.] license in the State of Wisconsin and willingness to be licensed in other states as required by law.
Additional professional certifications, such as CCM, COHN, CRRN, CDMS, and/or CRC.
Bachelor of Science in Nursing degree from an accredited college or university
Fluency in Spanish
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If you were eligible to this position, please email us your resume, with salary requirements and a resume to Secura.

If you interested on this position just click on the Apply button, you will be redirected to the official website

This position starts available on: Wed, 17 Apr 2013 03:19:02 GMT

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