Workers Compensation Claims Associate

Citi Med is a unique medical facility that provides exclusive healthcare amenities to our community. The range of medical and rehabilitative services offered has been specifically selected to treat traumatic injury patients. We provide a variety of health services including diagnostic and rehabilitation. Our vision directs the evolution of our practice, as we strive to improve our services to the community.

All Citi Med offices are multilingual and staffed with individuals to make any experience pleasant. You can learn more about us at

Citi Med is growing rapidly and we are looking for many qualifying individuals to be a part of our team! With the support and hard work of all our employees, Citi Med continues to make its way down a successful road. Citi Med maintains a work culture that allows our team members to feel supported and confident in their work. We offer many learning opportunities with room for professional growth.

The workers' compensation claims associate is responsible for the independent, prompt, and efficient evaluation, investigation, and resolution of assigned claims in accordance with legal statutes, policy provisions, and company guidelines to achieve positive results. Through effective investigation, coordination of medical care, negotiation, and interaction with clients, claimants, medical professionals, attorneys, and insurers ensure that the most advantageous outcomes are achieved, and client resources are utilized in a cost-effective manner.

This position also provides technical expertise and serves as an advocate on client claim issues.

• The workers' compensation claims associate is responsible for the independent, prompt, and efficient evaluation, investigation, and resolution of assigned claims in accordance with legal statutes, policy provisions, and company guidelines to achieve positive results.
• Through effective investigation, coordination of medical care, negotiation, and interaction with clients, claimants, medical professionals, attorneys, and insurers ensure that the most advantageous outcomes are achieved, and client resources are utilized in a cost-effective manner.
• This position also provides technical expertise and serves as an advocate on client claim issues.
• Promptly investigate all assigned claims from basic to more complex medical and indemnity files with minimal supervision.
• Make timely compensability determinations in accordance with jurisdictional requirements.
• Identify potential fraud indicators and notify management for further investigation.
• Notify excess carriers according to carrier guidelines, provide quarterly updates, and request timely reimbursement.
• Negotiate claims settlements within granted authority and accurately process and track award payments.
• Execute activities according to NY statute, best practices, and claim handling instructions.
• Highly effective verbal and written communication with internal and external parties to support the prompt resolution of claims and return to work in the most cost-effective manner.
• Analyze all Notice of Decisions issued by the Workers’ Compensation Law Judges as it pertains to any individual cases you might be working on, apply the Worker’s Compensation Law Judge’s C-8.1 ruling to any of your outstanding/disputed medical bills.
• Maintain current knowledge of all the forms used by the Workers’ Compensation processes (C-3; C-2F; C-4; C-4.2; C-4
  
  AMR; C-4.3; HCFA
  1500; MG-2; MG-2.1; C4-AUTH; HP-1; HP-2; HP-3; HP-3.1; HPA
  204; C-8.1; C-8.4; EOR; NOD; NOPCD; RD; AD; MOBPD; NOA; EC-325), rules & regulations (Section 325-1.25; HP-1/HP-J1 processes; Medical Treatment Guidelines & WC Medical Fee Schedule)
• Maintain a proper follow up system for all cases/claims that you previously…