Specialist-Claims Certified
Northeast Georgia Health System, Inc.

Work Shift/Schedule:
8 Hr Morning - Afternoon

Northeast Georgia Health System is rooted in a foundation of improving the health of our communities.

About the Role:

Job Summary

Primarily responsible for the investigation and management of workers' compensation claims. Conducts a 1 to 3-point contact on the managed claims, which is dependent on either the facts of the case or the claim type; determines compensability of claims, manages the medical treatment program, and assists in the return-to-work process. This includes calling and discussing potential claim activity and work-related injuries claimants and providers. Ensures best outcomes for employees in terms of a safe workplace, supervises care plans, and manages restricted duty for injured workers. Collaborates with employees, supervisors, care providers, claims processors, brokers, nurse case managers, and attorneys to properly manage work-related injuries.

Minimum Job Qualifications

• Licensure or other certifications: Claims Adjuster Licensure.
  
• Educational Requirements: Associates Degree. In lieu of a degree, five (5) or more years of relevant experience is acceptable
  
• Minimum Experience: Five (5) or more years experience in Occupational Health, Worker's Compensation, or other claims administration.
  
• Other:
  

Preferred Job Qualifications

• Preferred Licensure or other certifications:
  
• Preferred Educational Requirements:
  
• Preferred Experience:
  
• Other:
  

Job Specific and Unique Knowledge, Skills and Abilities

• Knowledge of insurance principles and claims administration
  
• Knowledge of Georgia Worker's Compensation regulations; ability to understand, interpret, and apply complex regulations to claims
  
• Knowledge of medical, insurance, and related legal terminology; ability to organize, analyze and interpret technical information
  
• Skill in examining documents for completeness, accuracy and compliance with specific requirements
  
• Ability to responsibly handle and maintain confidential information
  
• Ability to maintain effective working relationships with supervisors, injured workers, providers of care, and vendors
  
• Ability to prioritize work and perform duties with accuracy and attention to detail
  
  

Essential Tasks and Responsibilities

• Determines the validity and compensability of claims.
  
• Contacting employee/injured worker to obtain information related to their claim. Ability to take accurate documentation.
  
• Advises claimants of their rights and responsibilities while receiving medical care and provides assistance with the compensation process.
  
• Maintains detailed record for each claimant.
  
• Coordinates light/limited duty work assignments. Facilities the return to work process for all employees.
  
• Works with the third party administrator to ensure appropriate and timely claim information is set-up.
  
• Monitors medical costs associated with work related medical care including coordinating billing for work comp services for medical, equipment, and pharmacy changes. Reviews all medical bills to determine payment is accurate.
  
• Manages the on-going medical treatment program. Assist in creating Panel of Providers annually.
  
• Maintains up to date OSHA log at all times.
  
• Participates actively in quarterly claims reviews with attorney and claims adjuster.
  
• Actively participates in identifying trends, advising on remediation, and works with Employee Health Manager and department leaders on improvement ideas.
  
  

Physical Demands

• Weight Lifted: Up to lbs, % of time
  
• Weight Carried: Up to lbs, % of time
  
• Vision: Moderate, Frequently 31-65% of time
  
• Kneeling/Stooping/Bending: Occasionally 0-30%
  
• Standing/Walking: Occasionally 0-30%
  
• Pushing/Pulling: Occasionally 0-30%
  
• Intensity of Work: Occasionally 0-30%
  
• Job Requires: Reading, Writing, Reasoning, Talking, Keyboarding
  

Working at NGHS means being part of something special: a team invested in you as a person, an employee, and in helping you reach your goals.

NGHS: Opportunities start here.

Northeast Georgia Health System is an Equal Opportunity Employer and will not tolerate discrimination in employment on the basis of race, color, age, sex, sexual orientation, gender identity or expression, religion, disability, ethnicity, national origin, marital status, protected veteran status, genetic information, or any other legally protected classification or status.

This job has expired.