Job Description
Responsible for acquiring and analyzing workers compensation, claim information to manage data within scope of responsibility.
Responsibilities
- Gather, analyze, and manage workers compensation claim data, including medical records and work status updates, to ensure accurate and timely entry.
- Communicate with healthcare providers and stakeholders to collect and verify missing or unclear claim information.
- Collaborate with claim teams and escalate issues to internal or client contacts per SOPs to resolve RTW or job offer concerns.
- Partner with cross-functional teams to validate data, update internal guidelines, and maintain consistency with evolving client protocols.
- Research and improve processes, participate in ad hoc projects, and provide operational support to optimize efficiency and effectiveness.
- Conduct quality assurance reviews and evaluate final claim determinations to ensure compliance with regulatory standards.
- Test tools and workflows, document issues, and provide feedback to support continuous system and process improvement.
- Support year-end OSHA log creation, including reviewing client changes, preparing hours/headcount, and implementing required log updates.
Qualifications
- Bachelor's degree or equivalent.
- At least two (2) years working experience in a claims or insurance management services.
- Excellent oral and written communication skills.
- Highly organized thinking, writing and presenting so that key points are delivered powerfully and clearly to the intended audience.
- Capable of quickly learning new tools and programs.
- Able to manage multiple competing priorities.
- Proficient in MS Excel and PowerPoint.
- Skilled at simplifying complex concepts for a non-technical audience.
- Strives to establish and systematize best practices within team.
