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Workers Compensation Claims Specialist

Company: Brigham and Women's Hospital
Location: Somerville
Posted on: September 17, 2023

Job Description:

Job Description - Workers Compensation Claims Specialist (3254741) Workers Compensation Claims Specialist - ( 3254741 ) About Us As a not-for-profit organization, Partners HealthCare is committed to supporting patient care, research, teaching, and service to the community by leading innovation across our system. Founded by Brigham and Women's Hospital and Massachusetts General Hospital, Partners HealthCare supports a complete continuum of care including community and specialty hospitals, a managed care organization, a physician network, community health centers, home care and other health-related entities. Several of our hospitals are teaching affiliates of Harvard Medical School, and our system is a national leader in biomedical research.

We're focused on a people-first culture for our system's patients and our professional family. That's why we provide our employees with more ways to achieve their potential. Partners HealthCare is committed to aligning our employees' personal aspirations with projects that match their capabilities and creating a culture that empowers our managers to become trusted mentors. We support each member of our team to own their personal development-and we recognize success at every step.

Our employees use the Partners HealthCare values to govern decisions, actions and behaviors. These values guide how we get our work done: Patients, Affordability, Accountability & Service Commitment, Decisiveness, Innovation & Thoughtful Risk; and how we treat each other: Diversity & Inclusion, Integrity & Respect, Learning, Continuous Improvement & Personal Growth, Teamwork & Collaboration.
General Summary/Overview: The Mass General Brigham (MGB) Workers' Compensation Division is a self-insured, self-administered insurance division for MGB employees that become injured or ill in the course of their employment.The Workers' Compensation Claims Specialist is focused on Workers' comp lost-time claims management. The Claims Specialist reports to the Manager of the Workers' Compensation division and is mentored in workers' compensation laws to administer medical claims benefits. The claims specialist will also establish reserves, approve and process workers' comp benefits, and negotiate settlement of litigated claims. The claims specialist will also assist with administrative responsibilities as time permits including but not limited to OSHA recordkeeping and completing Workers' Compensation forms. Principal Duties and Responsibilities: - Review incident reports, investigate assigned claims as needed, and determine compensability. - Interact with injured employees to ensure awareness and understanding of the workers' compensation process, requirements, and entitlements. - Prepare and issue notices in accordance with mandated requirements and file state Department of Industrial Accident (DIA) forms as needed. - Establish claim reserve levels by estimating the cost of each assigned claim; monitor reserves and update amounts as necessary. Reserves should take into account likely medical and expense exposure. - Coordinate medical treatment for injured employees and provide information to treating physicians regarding employee's job requirements. - Reassign lost-time claims and litigated claims to the appropriate lost time claims specialist. - Review medical bills and employee expenses for payment and reimbursement. - Use appropriate cost containment techniques including strategic vendor partnerships for Utilization Review, and Bill Review Services. - Enter incident reports as needed and code them for OSHA recordable, injury type, body part,mechanism of injury and other pertinent information. - Other duties as assigned Qualifications:

  • High school diploma or equivalent ; Bachelor degree and/or relevant work experience highly preferred.
  • 2- 4 years of Workers' Comp claims management experience
  • Prior OSHA recordkeeping preferred a plus.
  • Knowledge of Medical and technical terminology used in industrial injury cases a plus. Skills/Abilities/Competencies - Strong written and verbal communication skills. - Negotiate issues and settlements for medical claims. - Gather, organize, compile and summarize data. - Identify issues and process claims in a timely fashion within the timeframes prescribed by law. - Create and maintain a variety of notes, tasks and reports for medical claims. - Promptly respond to requests and inquiries. - Prepare and maintain accurate financial records and documents for medical claims. - Operate office equipment including computers and associated software such as word processing, spreadsheet applications and Workers' Compensation software programs - Possess strong interpersonal skills to effectively communicate with cross-functional teams and customers. - Requires moderate direction from leadership and possesses the ability to learn quickly. - Supervisory Responsibilities: - No direct supervision; may provide guidance to other administrative staff on medical claims. Fiscal Responsibility: - No direct budgetary responsibility. - Prepare and maintain accurate financial records and documents for medical claims. -Working Conditions: - Environment: This position is a hybrid role requiring attendance both in the office setting and work from home. Standard office setting; exposure to computer screens. - Physical: Sufficient physical ability to work in an office setting; sit for prolonged periods of time and operate office equipment. The employee should be able to lift or move 5 pounds. - Vision: See in the normal visual range with or without correction; vision sufficient to read computer screens and printed documents. - Hearing: Hear in the normal audio range with or without correction. The noise level in the work environment is quiet to moderate. Primary Location MA-Somerville-MGB Assembly Row Work Locations MGB Assembly Row Job Human Resources - Other Organization Mass General Brigham Schedule Full-time Standard Hours 40 Shift Day Job Employee Status Regular

Keywords: Brigham and Women's Hospital, Somerville , Workers Compensation Claims Specialist, Other , Somerville, Massachusetts

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