Bilingual Claims Representative
Greater Denver Area
2 weeks ago
Contact stakeholders as required by Company best practices on incoming claims to promptly investigate circumstances of accident and injury, investigate and determine compensability, and identify and address red flag issues, including late reporting, pre-existing medical issues, designated medical provider process and referral issues, medical treatment issues, legal issues, and potential subrogation and penalty issues.
Determine compensability as required by Company best practices, case law and the Colorado Workers’ Compensation Act.
Manage open claims as required by Company best practices, including expedient and cost effective medical case management and disability management, as well as identification, investigation, management and resolution of potential adverse claim development, including prior injuries, co-morbid and pre-existing medical conditions, migrating body parts, worsening medical conditions and delayed recovery, change of physician requests, multiple claims, multiple jobs, subrogation, penalties and offsets.