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Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in workers' compensation claims processing, including data management, compliance with regulations, and effective communication with stakeholders. Proficient in utilizing claims management software and maintaining accurate records to support claim adjustments and inquiries.
Highest-signal resume keywords
Workers' Compensation Claims ProcessingData ManagementImageRight SoftwarePowersuite SoftwareOrganizational Skills
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Claims Statistical Data ProcessingData Error CorrectionsManual Medicare QueryClass Code CorrectionsTyping 45 WPM
Soft Skills
Verbal Communication SkillsWritten Communication SkillsListening SkillsProfessional Telephone Demeanor
Tools & Technologies
ImageRightPowersuite
Industry Keywords
Workers' CompensationClaims ProceduresClaims Maintenance ChecklistsVendor ReferralsLien Reviews
About the role
Key responsibilities & impact- Organizes the digital claim records for uniformity by removing duplicate records and top-lining documents
- Completes 10-day and 6-month claim maintenance checklists to ensure the highest level of claims statistical data processing
- Processes corrections to data error crits as required
- Completes manual Medicare query of claims at the CMS COB&R site as needed and documents the digital claim record
- Processes class code corrections that accurately depict the scope of an injured workers’ job and payroll
- Completes claim documents in both ImageRight and Powersuite
- Completes closure, re-opens, and reassignments of all claim files as submitted by Supervisory personnel
- Assists with record subpoenas and completes lien reviews organized with a worksheet summary
- Completes vendor referrals by service specialty and utilization review submissions to Rising
- Maintains contact with the WCAB for status updates on claims where named as a party to suit in error
- Complies with Maximus responses following IMR for timely fulfillment
- Reviews adjuster ImageRight tasks daily for medical authorization requests
- Provides administrative assistance to claim adjusting team members as needed
- Provides back-up in the entry of manual payments to the Claims Payable Analyst
Requirements
What you’ll need- Minimum Education: High School Diploma or equivalent
- Preferred Education: College degree preferred
- 1-2 years of relevant claims processing experience preferable in the worker’s compensation field or similar experience
- Thorough knowledge of workers’ compensation claims procedures and policies
- Professional telephone demeanor, good verbal and written communication skills, good listening skills
- Strong organizational skills
- Ability to type 45 WPM
- Basic understanding of business technology
Benefits
Comp & perks- Comprehensive medical insurance, dental insurance, and vision insurance
- Life and disability insurance
- Fertility benefits
- Wellness resources
- Paid sick time
- Generous paid time off and holidays
- Employee Assistance Program (EAP)
- Complimentary Calm app subscription
- Immediate vesting in a 401(k) plan
- Health Savings Account (HSA) and Flexible Spending Account (FSA) options
- Commuter benefits
- Employee discount programs
- Paid maternity leave and paid paternity leave (including for adoptive parents)
- Legal plan options
- Pet insurance coverage