Medical Only Workers Compensation Claims Examiner

Candidate selected to fill this position must live within the state of Georgia. The employee's telecommuting work site location will contain a designated and approved workspace at the employee's home address.

Employee is required to have and maintain a high-speed, broadband internet connection at their work site that is sufficient to enable fast, consistent service to the membership. A minimum download speed of 25 Mbps is required. To ensure a consistent speed at this level, a 40MB internet connection is recommended. You may check your download speed at www.speedtest.net.

General Definition of Work:

Performs moderately difficult technical work verifying compensability of worker's Compensation Claims, preparing and processing workers' Compensation Claims and related correspondence, contacting employers and medical providers, responding to customer and provider inquiries, and related work as apparent or assigned. Work is performed under the limited supervision of the Insurance Services Supervisor.

Position Responsibilities

• Supports the Association's "Four Pillars," civic engagement, leadership development, legislative advocacy, and membership services through the support of division or program staff and interaction with local governments and authorities; has knowledge of and general understanding of the programs and services offered by the Association and provides outstanding customer support that reflects well on the entire Association;
• Provides and exhibits outstanding customer service, teamwork, and organizational commitment;
• Checks worker's Compensation Claims diary periodically to identify newly assigned claims, ensures claims move toward appropriate closure within established time frames;
• Verifies compensability of workers' Compensation Claims, contacts employer and medical provider to verify claim facts and obtain additional information as needed to determine compensability, follows-up to verify work and treatment status. Identifies and pursues subrogation recoveries;
• Receives and responds to inquiries via telephone and e-mail, provides information or forwards caller to appropriate party;
• Performs proper and timely reserve evaluations and adjustments; reviews and approves bills for processing, reviews and signs off daily check report;
• Completes Electronic Data Interchange (EDI) transmissions, state board filings, and completes Centers for Medicare Services (CMS) requirements;
• Supports the overall organization by executing directives as set forth by the Association;

Education and Experience

• High school diploma or equivalent and
• Foundational level experience (typically 2 years) experience in worker's compensation claim administration, or
• equivalent combination of education and experience.