Claims Specialist

Cheyenne, WY - USA

Monthly Salary: Not Disclosed

Posted on: Yesterday

Vacancies: 1 Vacancy

Job Summary

Description and Functions

GENERAL DESCRIPTION:

The Wyoming Department of Workforce Services is seeking a detail-oriented and analytical Claims Specialist to join its Workers Compensation team.

In this role you will perform comprehensive case management functions for assigned employer accounts ensuring the timely and accurate handling of Workers Compensation claims. Responsibilities include determining the compensability of claims based on statute and policy reviewing documentation analyzing facts and making sound well-supported decisions.

The position also monitors claims activity for potential fraud abuse or other improprieties helping safeguard the integrity of the Workers Compensation program. This role requires strong critical thinking skills attention to detail and the ability to communicate clearly and professionally with employers injured workers medical providers and other stakeholders.

If you are committed to public service and take pride in ensuring fair consistent and accountable claims administration we encourage you to apply.

Working for the State of Wyoming offers more than a paycheck. Our total compensation package includes:

Comprehensive health dental and vision insurance
Paid vacation sick leave FMLA and holidays
Retirement - Pension and 457B plans that help you build a secure future
Flexible schedules and work-life balance options
Meaningful work that makes a difference for Wyoming communities and MUCH MORE!

Click here for detailed information or you can watch this short video to learn about our benefit package!

Want to see the full value of your compensation beyond salary

Explore our Total Compensation Calculator:

Human Resource Contact:

ESSENTIAL FUNCTIONS: The listed functions are illustrative only and are not intended to describe every function that 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 the 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 Bachelors 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:

Bachelors Degree

Experience:

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

Education & ExperienceSubstitution:

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

Certificates Licenses Registrations:

None

Necessary Special Requirements

NOTES:

FLSA: Non-Exempt
Former State of Wyoming employees who are rehired less than 31 days after their final day in their old agencymust repay all leave payouts.
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 E-Verify including your rights and responsibilities.
For the Veterans preference consideration supporting documentation must 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.

Click here to view the State of Wyoming Total Compensation Calculator.

URL: 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.

Required Experience:

Description and FunctionsGENERAL DESCRIPTION:The Wyoming Department of Workforce Services is seeking a detail-oriented and analytical Claims Specialist to join its Workers Compensation team.In this role you will perform comprehensive case management functions for assigned employer accounts ensuring ...