Pay Range: $35/hr to $37/hr

Responsibilities:

• Conduct telephone interviews and gather information from claimants, providers, and clients as part of medical appropriateness protocol procedures.
• Perform three-point contact, direct care into the network, follow up on treatment status, correspond with providers, and consistently document the file.
• Evaluate and coordinate treatment plans proposed by providers in accordance with established protocols, authorizing medical treatment and associated diagnostic testing on assigned claims.
• Act as a liaison with clients to identify issues related to medical care, treatment plans, and claim processing, forwarding concerns to appropriate parties when necessary.
• Initiate calls and correspondence to claimants, providers, and clients to coordinate courses of treatment. Review and identify claims involving complex injuries or treatment plans and refer them to a nurse case manager.

Education Qualification:

• A bachelor's degree is preferred.
• A minimum of two years of business experience is required, preferably in a medical support-related position or health insurance environment.
• Required Skills: Proficiency in using personal computers and supporting software in a Windows-based environment, including MS Office products (Word, Excel, PowerPoint) and Lotus Notes.
• Knowledge of medical terminology is required.
• Understanding of case management philosophy and process is preferred.