The Workers Compensation Claims Support Spec provides support and backup for the administration of workers' compensation claims for the organization.
This position requires critical thinking and excellent customer service. The Claims Administration Support will have considerable phone interaction with both internal and external stakeholders, leadership, and the WC Team. Consistently being at work and timely, is inherently required of this position.
Major Responsibilities: Must possess analytical skills and be able to work with a sense of urgency and accuracy. Must remain highly engaged and efficient supporting the Workers' Compensation Team within the standard of work guidelines. Must be able to monitor the Workers' Compensation phone line; return calls to provide answers, be able to offer guidance and/or support to the Workers Compensation Team. Must be able to assign claims to the proper WC Team Member to include sending acknowledgement letters, ISO inquiries, medical authorizations, setting initial reserves and diaries as well as maintain a diary. Must be able to monitor and accurately attach incoming medical records, mail/email/faxes to open/closed files. Must be able to process tasks/requests as requested by WC Team and other customers; including butnot limited to vendor maintenance in claims administration system, handling check and payment requests, billing issues/inquiries and the resolution of those issues/inquiries and Research returned checks/payment, determine resolution then resend or void payment. Must be able to request offsite records and follow-up on outstanding items as needed. Must be able to complete required state forms for WC Team upon request. Must be able to maintain strict confidentiality of information at all times of a sensitive nature and/or protected under state and federal law. Must be able to provide additional support for all other projects and duties as assigned. Education Requirements: High School diploma required; Bachelor's degree a plus. Experience Requirements: One or more years of Workers' Compensation and/or Liability claims support or handling experience, customer service or generalclerical experience. Knowledge, Skills & Abilities Required: Must be able to prioritize work. Must work with a sense of urgency and accuracy. Must be able to work independently and with a team. Must have familiarity with medical terminology. Must be able to manage multiple tasks simultaneously, make difficult decisions and focus on details. Must have excellent verbal and written communication skills. Must be proficient in Microsoft Office products. Limited access to protected health information (PHI) to the information necessary to do the job. Sharing of information only on a need-to-know basis for work purposes. This job description indicates the general nature and level of work expected of the incumbent. It is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities required of the incumbent. Incumbent may be required to perform other related duties.
