Key Responsibilities
1. Medical Review & Case Evaluation
- Review medical records and treatment plans related to motor vehicle accidents (MVA).
- Assess injury severity and determine if treatments are necessary.
- Verify if injuries are accident-related and identify pre-existing conditions.
- Review MRIs, surgical recommendations, injections, and other medical procedures before approving funding.
2. Claims & Funding Management
- Approve or deny treatment requests based on policy limits and estimated settlement value.
- Manage Letters of Protection (LOPs) and medical liens.
- Review medical bills to ensure charges are accurate and reasonable.
- Prevent billing issues such as overcharging or upcoding.
3. Provider & Case Coordination
- Coordinate patient treatment with approved medical providers.
- Find providers close to the patient's location to improve treatment consistency.
- Monitor cases throughout the treatment phase to avoid delays before settlement.
4. Communication & Support
- Act as the main point of contact between patients, medical providers, and attorneys.
- Handle concerns related to denied treatments or billing disputes.
- Coordinate with legal teams and medical offices for smooth case processing.
Required Skills
- Strong understanding of medical records, treatment plans, and diagnostic reports.
- Experience using CRM systems such as Filevine, Salesforce, or Smart Advocate is preferred.
- Knowledge of medical billing and personal injury case processes.
Preferred Qualifications
- Background in Nursing, Physical Therapy, or related healthcare field.
- Experience handling medical liens and Letters of Protection (LOPs).
- Familiarity with At-Fault insurance states such as Colorado and Arizona is an advantage.
