Michael Caputo Email & Phone Number

Jersey City Nj

Responsible for handling NJ, PA & DE workers’ compensation cases for lost time, litigation and medical management

Baskin Ridge Nj

Responsible for handling NJ workers’ compensation cases for lost time, litigation and medical management on behalf of liquidated insurance carriers.

Basking Ridge Nj

Responsible for handling NJ workers’ compensation cases for lost time, litigation and medical management on behalf of liquidated insurance carriers.

Neptune Nj

Responsible for active NY and NJ Lost Time claims from inception to closureProcess workers’ compensation claims determining compensability and benefits due on long term indemnity claims, monitors reserve accuracy, and files necessary documentation with state agency.Develops and manages workers’ compensation claims action plans to resolution, coordinates return to work efforts and approve claim payments.Approves and processes assigned disability claims, determines benefits due, and manages action plan pursuant to the disability claim or client contractManage subrogation of claims and negotiate settlements.Communicates claim action / processing with claimant and client.Ensures claim files are properly documented and claims coding is correct.Maintains a quality assurance program to support the Total Performance Management initiative and the consistent delivery of quality claims service.Handle active caseload for a dedicated national account and State Localities (Millennium Hotels, NJIFF.

Melville, Ny

Contract assignments include: Sedgwick CMS, Melville (1/2011 – 8/2011, Gallagher Bassett Services, NYC (12/2010 – 1/2011), Sedgwick CMS, Melville (7/2010 - 12/2010)Responsible for active NY and NJ Lost Time claims from inception to closureProcess workers’ compensation claims determining compensability and benefits due on long term indemnity claims, monitors reserve accuracy, and files necessary documentation with state agency.Develops and manages workers’ compensation claims action plans to resolution, coordinates return to work efforts and approve claim payments.Approves and processes assigned disability claims, determines benefits due, and manages action plan pursuant to the disability claim or client contractManage subrogation of claims and negotiate settlements.Communicates claim action / processing with claimant and client.Ensures claim files are properly documented and claims coding is correct.Maintains a quality assurance program to support the Total Performance Management initiative and the consistent delivery of quality claims service.Handle active caseload for a dedicated national account, Verizon

Whippany, Nj

Handle workers compensation claims for multiple clients within the Northeastern State JurisdictionsState Jurisdictions include (ME, MA, RI, CT, NH, NY, NJ, PA, MD, and DC)File appropriate forms timely within each state.Medical TreatmentObtain all initial-treating records from emergency room, hospitals and physicians.Monitor and authorize all treatment when appropriate.Schedule IME to determine necessity of continued treatment and/or recommended treatment courseBill ProcessingReview all medical bills to see if treatment was authorized and process for payment.Set / Adjust appropriate reserves on all files.

Long Island City, Ny

File NYS Workers’ Compensation Board FormsComplete 3-point contact (Claimant, Insured and Provider)Review medical bills for payment and causal relationship within 20 days of receiptAdjust ReservesIssue bi-weekly payments to the claimantPrepare files for hearingFile Notice of liens in third – actionsSettle cases through Section 32 processNegotiate settlement of outstanding medical billsRequest appeals where applicableAssign cases for IME, investigations and case managementMaintain 1:1 closing ratioMaintain daily diary of pending claims

New York, Ny

Monitor Minor Lost Time/PPD CasesProcess payments for prior TTD when claimant has already returned to workContinue PPD payments on classified cases with no possible settlement (no Section 32, Death payments, etc.) Transfer file to Claims Facilitator if continued lost timeObtain all initial-treating records from emergency room, hospitals and physiciansMonitor and authorize all treatment when appropriateSchedule IME to determine necessity of continued treatment and/or recommended treatment courseTransfer claim to Claims Facilitator if treatment is other than for established sitesReview all medical bills to see if treatment was authorized and process for paymentSet appropriate reserves on all files

Parsippany, Nj

Provide efficient and accurate service to clients, lawyers and vendorsIntake all information of new auto claims via telephoneProcess medical, indemnity and expense payments through computer based programsProcess incoming and outgoing mailAssist adjusters with clerical dutiesDaily use of Lotus Notes, Microsoft, Word Perfect and 18 line Meridian phone system