| At Montana State Fund, serving the businesses of Montana is what we do, who we are, and what makes us different. We partner with employers and their employees to care for those injured on the job and we champion a culture of workplace safety for our fellow Montanans. About the Role As a claims examiner trainee, you would receive a high level of direction and instruction to manage an assigned caseload of non-complex indemnity and medical only claims with limited and supervised authority. The Montana State Fund's training program leverages an interactive process with a combination of learning techniques for trainees to learn the workers' compensation system of Montana, Montana State Fund (MSF) Best Claim Practices and overall workers' compensation claim management. If you are someone that thrives in a fast-paced, dynamic learning environment that immediately puts the learning into professional practice, this may be an excellent career opportunity for you to develop the knowledge, skills and abilities necessary to perform the duties of an entry-level claims examiner position. If this sounds interesting and you would like to work in a collaborative environment with a team of passionate, motivated professionals, please read on to learn about the essential functions, duties and required minimum qualifications for the claims examiner trainee opportunity! What You Will Do - Within the context of the Claims Examiner Trainee Program manages an increasing case load of medical only and indemnity claims in accordance with Best Claim Practices and applicable state law. Includes all aspects of claim investigation, indemnity management, medical management and financial management within authority levels. With direction, instruction and oversight responds to injured worker, provider, and policy holder inquiries and participates in claims review meetings with customers and producers. (65%)
- Learns in both oral and written formats, attends classroom training, completes assigned coursework, takes direction, accepts mentoring and coaching to learn new skills and participates in Claim Review process to test and improve knowledge and skills. (35%)
Key Activities - With direction, instruction and oversight, investigates, evaluates, negotiates, and resolves claims in accordance with Montana State Fund Claim Guidelines and industry Best Claim Practices.
- Calculates and authorizes payment of medical and indemnity benefits within limits of authority and according to Montana Code Annotated (MCA) and fee schedules.
- Appropriately handles policyholder and injured worker confidential information according to MSF policies.
- With instruction, direction and oversight, manage diary and complete activities and tasks to ensure that claims move to the best outcome and timely resolution.
- Demonstrate increasing ability to successfully manage vendors in course of claim management.
- With instruction, direction and oversight, analyze liability issues determine exposure to properly set claim reserves.
- With instruction, direction and oversight, obtain all necessary and pertinent claim file documents to achieve thorough work file documentation.
- With instruction, direction and oversight, for all claims and within timeframes outlined in MSF Claim Guidelines and industry Best Claim Practices, identify, document, and implement the claim strategy and steps to achieve resolution of each assigned claim.
- With instruction, direction and oversight, demonstrate progressive growth in sound decision-making for all aspects of claim handling including reserve and settlement decisions.
- With instruction, direction and oversight, coordinate the assignment and management of expert resources to assist in case resolution. Includes, but not limited to, peer review, legal resources, nurse case management, vocational rehab, designation of primary care provider, and/or other appropriate resources.
- With instruction, direction and oversight, thoroughly investigate, evaluate, & present findings on potential catastrophic claims.
- With instruction, direction and oversight, prepare annual reserve updates and a plan of action for all assigned claims including presentation of same to designated claim experts on all catastrophic and large loss claims.
- Continuously seek and accept claim management feedback in support of the MSF Claim Guidelines and industry Best Claim Practices.
- Attend, participate, and demonstrate understanding and application of training on applicable Montana Workers’ Compensation statutes and Montana Code Annotated, case law, as well as the MSF Claim Guidelines, systems, and policies and industry Best Claim Practices.
- With instruction, direction and oversight, respond to injured worker and policyholder inquiries, adequately explain the workers’ compensation claim process in layman’s terms, and assist the injured worker and policyholder to understand the claim handling process throughout the life of the claim.
- Demonstrate increasing ability to develop and maintain positive working relationships with injured worker attorneys, medical providers and vendors.
|
