Workers' Compensation Claims Specialist 2024-01255

Description and Functions

Open Until Filled

GENERAL DESCRIPTION:

Performs case management function of Workers' Compensation for assigned employer accounts, determines compensability of cases, and monitors fraud and improprieties.

Human Resource Contact: kelly.gayer@wyo.gov

ESSENTIAL FUNCTIONS: The listed functions are illustrative only and are not intended to describe every function which may be performed at the job level.

• Use case management skills to guide customers through the Workers' Compensation benefits program.

• Review injury reports.

• Investigate the circumstances of the injury.

• Make eligibility determinations on a claim for benefits by reviewing applications and medical reports.

• Process claims for indemnity benefits.

• Communicate clearly the rights, responsibilities, and benefits of the Workers' Compensation program.

• Assist injured workers with filing requirements and understanding the complex claims processes.

• Refer appropriate cases for hearing and may provide testimony in the hearings.

• Respond directly to employers or vendors in regard to questions on procedures or the status of cases or claims.

• Coordinate return to work and work restrictions with healthcare providers and employers.

• Analyze medical documentation to determine the compensability of claims.

• Initiate and monitor program requirements and processbenefits.

• Mediate disputes involving injured workers, employers, healthcare providers, and the division.

• Coordinate with healthcare providers to effectively manage the compensable injury and establish appropriate diagnoses and treatment plans for the injury.

Qualifications

PREFERENCES:

Preference may be given to those with Claims Management and/or Claims Service experience.

Preference may be given to those with Customer Service experience.

Preference may be given to those with a Bachelor's degree in Management and/or Social Services.

KNOWLEDGE:

• Knowledge of Workers' Compensation Law and Rules & Regulations.

• Ability to assist clients in working through complex processes.

• Ability to work independently.

• Ability to analyze situations and provide resolutions within the statutes.

• Knowledge of medical terminology.

• Knowledge of case management.

• Knowledge of customer service.

MINIMUM QUALIFICATIONS:

Education:

Bachelor's Degree

Experience:

0-1 year of progressive work experience (typically in Benefits and Eligibility)

OR

Education & ExperienceSubstitution:

3-4 years of progressive work experience (typically in Benefits and Eligibility)

Certificates, Licenses, Registrations:

None

Necessary Special Requirements

PHYSICAL WORKING CONDITIONS:

• This position takes place in an average work environment.

• Some travel may be required.

NOTES:

• FLSA: Non-Exempt

• The Wyoming Department of Workforce Services (DWS) uses E-Verify, an Internet-based system, to confirm the eligibility of all newly hired employees to work in the United States. Learn more about https://www.e-verify.gov/, including your rights and responsibilities.

• Former State of Wyoming employees, who are rehired within 31 days from their previous employment, will be required to reimburse the State of Wyoming for all Vacation and Sick leave compensation received upon separation.

• For the Veteran's preference consideration, supporting documentationmust accompany your application.

• Offers of employment will be contingent upon the successful completion of a background check.

Supplemental Information

Click here to view the State of Wyoming Classification and Pay Structure.

URL: http://agency.governmentjobs.com/wyoming/default.cfm

The State of Wyoming is an Equal Opportunity Employer and actively supports the ADA and reasonably accommodates qualified applicants with disabilities.

Class Specifications are subject to change, please refer to the A & I HRD Website to ensure that you have the most recent version.