WORKING CONDITIONS: 

Work is performed in an office setting with no unusual hazards. 

Internal Candidate: An incumbent who does not successfully obtain a MI or TX licenses at the end of the 180 days will not be placed in a MOCS role. If the Company is unable to return the incumbent to a bargaining-unit job the incumbent will then be placed on the recall list in accordance with Article 8.8 of the Collective Bargaining Agreement. 

External Candidate: Initial probationary period 180 days. Successful completion of probationary period requires adjuster license obtained in either MI or TX. 

NOTES:  

An incumbent who does not successfully complete the training plan at the end of the 12 months will not be placed in a Medical Only Claims Specialist I position. If the Company is unable to return the incumbent to a bargaining-unit job the incumbent will then be placed on the recall list in accordance with Article 8.8 of the Collective Bargaining Agreement. 

• Assist Medical Only Claims Specialist with the investigation and management of workers’ compensation claims. 
• Assists with determining and managing the on-going medical treatment program including directing care, creating panels, and approving provider requests. 
• Evaluates medical reports and correspondence for appropriate action/documentation. 
• Supports the customer service work and processes for the multi-functional claims team; Communicates and collaborates with team members to ensure the appropriate and timely handling of claims in other states. 
• May be required to act as a backup to the MOCS. For items such as Verifies workers’ compensation coverage of employers and injured employees. 
• Documents specifics of claims with potential for subrogation.  
• Approves payment based on knowledge of the treatment plan and medical support showing relationship of treatment to the injury. 
• Concludes and closes files following resolution of claims to meet internal performance standards while complying with state legislation to avoid penalties and manage expenses. 
• Coordinates with outside vendors to ensure cost containment efforts.  
• Establishes and maintains effective working relationships with all internal and external customers. Assists with determining appropriate response to regulatory inquiries. 
• Composes correspondence and various reports in the administration of workers compensation claims; sets appropriate diaries.  
• Reads, routes and keys incoming mail, runs reports and answers/responds to incoming phone calls on both direct and ACD line, faxes and emails. This may include completing work for peers during absences to provide uninterrupted service to customers. 
• Demonstrate growth of skills working towards the more complex responsibilities of the Medical Only Claims Specialist I position. 
• Increase knowledge of how Accident Fund Insurance Company of America runs and how Workers’ Compensation Insurance works.