Workers Compensation Technician

SCOPE OF RESPONSIBILITIES:

The core business of the school system is to provide students with engaging challenging schoolwork in which they persist when they experience difficulty and from which they gain a sense of satisfaction. Therefore all district activity must be organized around students and the work that students do.

Responsible for performing minor adjusting duties and any assigned clerical duties that are required for the efficient implementation of the SelfInsured Workers Compensation Program including but not limited to the maintenance of manual & electronic claim files communication with medical providers review of fees coding and verification of accident forms sorting numbering and electronic scanning and posting of daily correspondence in the Workers Compensation Office as well as minor adjusting of medical only and any other claims as assigned by the Claims Coordinator including verification of coverage approval of care and processing of corresponding bills.

PERFORMANCE RESPONSIBILITIES/ESSENTIAL FUNCTIONS:

• Acts as primary claims processor and maintains a current electronic diary for all medical only claims and occasionally on any other claims as assigned by supervisor. Maintains indemnity payments through ICE system on any specifically assigned claims. Opens stamps sorts and numbers all incoming mail. Arranges mail for each claim number type and function then scans it into the computer system and electronically posts it of the appropriate claim file for adjuster review. Identifies all legal and/or time sensitive correspondence and posts electronically directly to Coordinator. Facilitates flow of paperwork on all claims.
• Place coding and salary information from computer onto all accident reports as received for review. Verifies absence dates and return to work information with the school and determines if and where medical care was sought. Submits accident reports to supervisor for initial overview and screening.
• Maintains a current suspense file by policy year on all reporting only accidents as indicated and/or enters claims into computer system as an RO claim once technology is available as directed by supervisor.
• Enters all lost time and medical only accident claims into ICE System obtains a claim number and prepares a State form 1007 on all accidents including wage and lost time information sends a copy to Safety Department and Personnel. Sends a copy on all reportable accidents to La. Dept. of Labor OWC.
• Calls schools employees and medical provides as necessary to verify absence dates and return to work dates on all accidents and maintains contact as necessary to establish if and where medical care was sought. Further requests the appropriate documentation either by mail or form letters from any and all involved parties.
• Posts electronic mail in proper date order within each claim file on a timely basis. Pulls all main and claim files as requested for supervisor review.
• Answers department telephone and takes manual and/or electronic messages as required and places them into the ICE system for recording and/or retrieval.
• Receives and responds to calls requesting status on bill payments. Researches and resolves billing problems.
• Receives calls for verification of coverage from medical provider. Calls school to verify accident determines within designated authority whether treatment requested is appropriate and related to claim and calls back to approve treatment on new claims.
• Eliminates all duplicate bills and correspondence by checking existing postings.
• Functions s medical only claims processor/adjuster on all medical only claims and any other claims assigned by supervisor. This includes but is not limited to reviewing the bills for relatedness to the individual claim and being responsible for the successful payment of each such bill and resolves all related claims issues within reserve authority. Accurately identifies all problems potential problems that would be beyond authority level and refers to supervisor for review.
• Places proper claim number on all outgoing main to TPA and/or Bill Review facility. Enters manual payments as required.
• Assists in all correspondence for Claims Coordinator such as main checks to be signed and all clerical duties.
• Makes requests for CPT coding and requests for medical reports to doctors and hospitals etc. when indicated.
• Refers all call from attorneys and physicians to Claims Coordinator.
• Photocopies correspondence as directed and prepares a copy of entire file and/or prints copies of electronically attached correspondence when requested.
• Maintains a payment diary for MCU claims. Issues checks to MCU claimants obtains signatures and mails on proper dates.
• Verifies that a corresponding medical report or note has been received for each incoming bill. Review for appropriateness and prior authorization to bill. Prepare and send bills for fee schedule compliance review.
• Performs all other duties assigned by the Claims Coordinator.

WORK ENVIRONMENT/HOURS WORKED:

Required to work in an office type setting climate controlled environment adhering to School Board energy policy. File retrieval from nonclimate controlled warehouse is rarely required. Travel to accident site for investigation may be required on special occasions. Work day consists of eight hours per day including one hour lunch and two 15 minute breaks as approved by supervisor. Workday may be adjusted for Board approved summer schedule/emergencies.

COMMUNICATION SKILLS:

Must be able to communicate proficiently in English both orally and in writing. Must have ability to accurately give receive and accurately document any phone calls conversations recorded interviews mail and faxes received. Must be able to communicate successfully accurately professionally and pleasantly with the public.

TECHNOLOGY SKILLS:

EQUIPMENT USED:

Telephone computer scanner facsimile machine calculator copy machine printers folding machines and other appropriate office machines.

PHYSICAL INVOLVEMENT:

Sitting is required most of the day. Must be able to operate office equipment. Standing walking reaching bending and lifting up to 20 pounds is sometimes required.

MENTAL INVOLVEMENT:

Must understand and interpret written and verbal instructions from supervisor. Must be able to work independently with minimal supervision. Must have ability to learn various computer software programs. Must have ability to manipulate data with accuracy.

HUMAN RELATIONS INVOLVEMENT:

Must be able to work compatibly in group settings. Must be able to respond positively to supervision and accept suggestions for improvement.

MINIMUM QUALIFICATIONS:

• High school diploma or equivalent.
• Passing score on computer test.
• Demonstrated ability to perform mathematical calculations.
• Demonstrated knowledge of basic medical technology especially trauma related terms.
• Experience as a file clerk or medical only clerk claims processor for an insurance or adjusting company and/or experience working in a physicians office and/or experience in medical coding and billing or experience in an equivalent position with applicable transferable skills.
• Demonstrated ability to communicate easily and concisely with people.

DESIRABLE QUALIFICATIONS:

• Claims processing experience preferably in the area or workers compensation.
• Prior claims adjusting experience is preferred or experience in casualty insurance claims field.
• Prior experience with scanning and posting electronic mail.

Required Experience:

IC