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Special District Risk Management Authority (SDRMA) is a public agency that provides a full-service risk management program for California’s local governments. For over four decades, SDRMA has provided members with comprehensive coverage protection.
One of SDRMA’s greatest assets is its staff. SDRMA employees are smart, creative, hardworking, and passionate individuals working in areas ranging from risk control, claims administration, information technology, accounting, and risk pool administration. Working here requires energy, commitment, and teamwork. We are looking for an individual who shares these values to join the SDRMA team
The Medical Only/Claims Examiner I is responsible for handling workers’ compensation Medical-Only claims of SDRMA’s members from inception to resolution in addition to serving as assistant to the claims staff and Workers’ Compensation Claims Manager in the administration and processing of claims data; establishes and maintains claims files; inputs data into the claims system; updates current records as necessary; assists with the record keeping and distribution of loss run reports; contacts member agencies concerning the status of claims and information requests; prepares correspondence related to claims assignments; perform other work related duties, as required.
• Handling Medical Only claims for all members.
• Communicates claim activity and processing with the injured employees and the members; maintains professional member relationships.
• Ensures claim files are properly documented, and claims coding is correct.
• Refers cases as appropriate to supervisor and management; Reviews medical-only claims at 90 days to determine if transfer requirements are met.
• Maintain 100% closing ratio on active accounts.
• Complete 3-point contact within 1 business day.
• Sets up and enters new claims into claims management system.
• Inputs and reviews notes/diaries in claims management system as instructed.
• Processes payments.
• Processes mail; handles filing, faxing and photocopying.
• Reviews, prepares, creates, and/or sends letters, reports, and forms.
• Answers and initiates telephone calls as back-up to Claims Examiner I, sets up medical appointments, and may provide customer service as required.
• Other activities/projects as assigned including the preparation and distribution of computer reports.
