Overview

Health Management Solutions (HMS) is looking for a FROI/RR Claims Examiner to work full time in their in Columbus, Ohio location. Health Management Solutions is an Ohio Managed Care Organization (MCO) focused on reducing lost work time. Our safety and education programs help reduce work place injuries while hands-on workers’ compensation case management and our extensive health provider network help injured workers return to work quickly and safely while working within BWC designated guidelines.

 

The FROI/RR Claims Examiner processes workers’ compensation claims ensuring that accurate and complete information is given to the Ohio BWC.  They also case manage minor injuries to promote a successful return to work for the Injured Worker. The primary responsibility is to establish a three point contact of communication and collaboration between the injured worker (IW), employer, and provider. It is their responsibility to make sure they are adhering to all HMS policies and URAC standards and Confidentiality policies and guidelines. The Claims Examiner Ensures that all documentation is current, accurate and complete and keeps diaries current. They also obtain modified duty availability from employers and communicate those duties to providers and IWs. As well as, obtain restrictions to a full RTW from provider and communicate to the employer and IW. The Claims examiner staffs C-9 requests with the Nurse Case Manager, or Medical Director and all difficult cases with the Nurse Case Manager and refers to them when appropriate. They participate in educational and informational seminars as needed including all HMS training.

 

 

 

Job Requirements

 

  • Must have a High School Diploma or equivalent
  • Managed Care Organization/Third Party Administrator experience preferred
  • Knowledge of medical terminology preferred
  • Proficient in Microsoft products