Workers Comp Claims Admin

Department: Human Resources
Hours: Per Week 40.00
Location: Community Hlth Plz/Ike Friedma
Shft: DaysJob Description:Collects injury reports and employee information to process incidents into Claims Management Database System. Provides for Electronic Data Interchange (EDI) to the Nebraska and Iowa Workers' Compensation Courts as required by state law or administrative ruling to report a claim. Determines the compensability of claims and services. Consults with Workers' Compensation Manger and legal counsel when denial for services is considered and publishes written denials when a determination if finalized. Audits all bills for services and provides payment in accordance with the Nebraska Fee Schedule and/or reasonable & customary charges as in the state of Iowa. Arranges for external bill review when needed (e.g. dental claims). Determines the compensability of services and administrates a resolution decision with the Workers' Compensation Manager and counsel when needed. ComputesC and provides temporary disability benefits in accordance with state law. Prepares claim payment on Claims Payment Account checks and forward to employees or designated service providers. Computes permanent indemnity compensation costs and arranges for settlement of claims with employee and/or her/his designated legal counsel. Administrates all permanent indemnity payments in accordance with state law and legal decisions. Discuss all proposed indemnity claim settlements with Workers' Compensation Manager prior to negotiations with employee's counsel.Experience Required: Minimum of 3-5 years of experience in Workers' Compensation administration, preferably in the states of Nebraska and Iowa. Computer experience in Window's based database management / application systems.Education/Licensure Required: Bachelors degree in business administration or similar field. Preferred: Workers Compensation Certification and continuing education in workers compensation and insurance administration.Knowledge/Skills/Abilities: Job requires proficiency in computer skills for use with Word, Excel, PowerPoint, STIX, web-based data management systems and standard office equipment. Must understand laws/regulations governing workers compensation and medical terminology. Must possess strong organizational skills, telephone skills, good interpersonal skills and excellent written and verbal skills. Significant interaction between employers, providers and management. Good negotiation and interpersonal skills.
REQUIREMENTS
Please see Job Description