Worker's Comp Claim Specialist

The Sheakley Group Inc

About The Position

The Return-to-Work Specialist manages workers’ compensation claims by coordinating communication between employers, injured workers, medical providers, and the Bureau of Workers’ Compensation (BWC). This role focuses on timely claim processing, accurate documentation, and facilitating safe return-to-work outcomes. The Specialist monitors claim progress, gathers necessary information, and provides excellent customer service while meeting quality and productivity standards.

Requirements

Knowledge and skills at a level normally acquired through the completion of a high school education or equivalent.
Typing speed of 40+ WPM.
Proficiency in Microsoft Office products including Word, Excel and Outlook.
Average computer skills required, above average skills preferred.
Attention to detail, flexibility, and ability to multi-task.
Ability to maintain accuracy and production requirements.
Ability to problem solve.
Ability to handle sensitive information and maintain a high level of confidentiality.
Ability to effectively prioritize tasks.

Nice To Haves

Previous customer service experience preferred.
1 year of previous claim or workers’ compensation related experience preferred.
Medical terminology or equivalent experience preferred.

Responsibilities

Directly reports to the Return-to-Work Specialist Team Leader and\or Claims Supervisor.
Responsible for entering initial claims when necessary, completing initial and subsequent contact to employer, provider, IW, and BWC as appropriate while accurately documenting the results of gathered information.
Responsible for complete follow-up on claims, including transferring to Case Management when appropriate, or case closure as appropriate.
Responsible for gathering and documenting any information on (RTW) return to work, missing claims master fields, continued treatment, etc.
Responsible for facilitating return to work by communicating with the employer, TPA, provider, injured worker, attorneys and BWC as appropriate.
Responsible for gathering complete information on all mandatory field requirements to ensure transmission to the BWC.
Responsible for obtaining additional medical information and/or C9s to move claims towards RTW (return to work) or other forms of claim resolution.
Responsible for completing follow-up on all subsequent documents for potential claim updates and communicating any claim updates to the appropriate parties.
Responsible for proactively and aggressively pursuing a safe and timely (RTW) return to work outcome for all managed claims thereby positively impacting MOD. This includes regularly utilizing RTW tools such as vocational rehab, field case managers, modified duty task lists, etc.
Responsible for providing excellent customer service to both internal and external customers.
Responsible for assisting other Return to Work Specialists and Claim Review Specialists as needed. Will assist with claims assigned to the CM in terms of employer needs, but do not perform any tasks related to the clinical case management of the IW.
Responsible for re-opening claims when injury re-aggravation or additional medical treatment deems it appropriate.
Required to meet team quality, productivity, and optimal RTW standards.
Required to maintain work queues- including processing documents within one business day and keeping claim memos current.
Required to respond to voicemails, emails and other messages in a timely manner (1 business day).
Required to log into any applicable call centers on a daily basis.
Required to prepare for and attend client meetings when applicable.
Responsible for maintaining and developing team work with all departments of UniComp.
Demonstrates and promotes Sheakley Core Values.
Other miscellaneous duties/projects as assigned by management.