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Job Field: Office Jobs
Location: LAKE OSWEGO, WA
Salary: $-
Job Type: Part Time

JOB SUMMARY:

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               <td align="left"><font style="font-size: 100%;">First Party Medical Claim Representative - Lake Oswego, OR Job<BR>Apply now &raquo;<BR>* Apply now<BR>* <BR><BR>Start apply with LinkedIn <BR>* <BR><BR>Start apply with Facebook <BR>* <BR><BR>Apply Now <BR>Email<BR><BR><BR>* <BR>Please wait...<BR><BR>Travelers<BR>Date:Oct 5, 2012<BR>Location:Lake Oswego, OR, US<BR>Solid reputation, passionate people and endless opportunities.<BR><BR>That''s Travelers. Our superior financial strength and consistent record of strong operating returns mean security for our customers - and opportunities for our employees. You will find Travelers to be full of energy and a workplace in which you truly can make a difference.<BR><BR>SUMMARY:<BR>Handle 1st party Auto Personal Insurance medical claims and some Business Insurance (BI) medical claims (BI that have the potential for 1st party collision claims).<BR><BR>PRIMARY DUTIES:<BR>- Handle a mix of low to high complex cases. Settlement authority and claim severity will vary. The office location may receive either No Fault claims or Med Pay claims or a combination of both.<BR>- Analyze and make coverage determination. Consider jurisdictional issues that will affect the type and amount of coverage provided. Verify the benefits available, the injured party-s eligibility and the applicable limits (based on the state laws and endorsements) Address proper application of any deductibles, co-insurance, etc. Confirm priority of coverage i.e.: primary, secondary, concurrent or not applicable, and take into consideration other issues such as Social Security, Workers- Compensation or others relevant to the jurisdiction.<BR>- Contact all appropriate parties to obtain all relevant facts necessary to determine coverage, medical necessity, treatment plan, causation/damages, and exposure with respect to the various vehicle coverage provided.<BR>- Determine causality by investigating injury claim. Properly manage medical process, determine the nature and extent of injury, mechanism of injury, type of treatment received or anticipated and employment information and status.<BR>- Establish timely and maintain appropriate claim and expense reserves.<BR>- Develop and continually update a plan of action including maintaining an effective diary to bring the claim to resolution in a timely manner. Manage file inventory by utilizing an effective diary system and documenting claim file activities in accordance with established procedures.<BR>- Conduct thorough Investigation into wage loss and essential services claims including verification of coverage, employment, loss of income due to accident and medical disability to support wage loss or need for essential services to ensure validity of the claim.<BR>- Proactively manage medical treatment and wage loss through case management and use of medical resources such as nurse case manager, independent medical examinations and Peer Reviews. Aggressively monitor the process to ensure proper payment, (i.e.: review medical bills and medical records for appropriateness of billing/fees and the services rendered ensuring that all records have a determination of m                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    </font></td>
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