Examines routine claims covered under South Carolina laws and regulations; may authorize payment of benefits.
Audits claim files to determine if claim is properly completed.Analyzes claims for deficiencies in supporting medical documents, payroll documents, and lost time records for claimants.Analyzes information and decides which claims should be forwarded to the investigative unit for review.Examines claims to determine benefits which have been awarded by the courts or settled on release agreements.Determines incurred losses from open files.Contacts physicians, payroll staff, employees and supervisors to obtain additional information regarding claims.Verifies documentations with initial claim file.Prepares reports that determine trends in accidents and work-related illnesses.Responds to inquiries by telephone or correspondence regarding claim status.Advises on proper claim processing.
Knowledge of South Carolina laws and regulations.Knowledge of medical and insurance terminology.Knowledge of office practices, procedures and equipment.Ability to analyze and draw valid conclusions from documentary evidence.
Associate degree or equivalent combination of education and experience.