What are the responsibilities and job description for the Urgent Need Program Assistant 2 / Worker’s Compensation Specialist - Madison, WI (Onsite) position at Vinsys Information Technology Inc?
We are seeking one qualified candidate for a temporary Program Assistant 2, functioning as a Worker s Compensation Specialist Health Cost Disputes, supporting the Wisconsin Department of Workforce Development s Worker s Compensation Division. Pl. go through the below description and let me know your interest. If you are interested, kindly share a copy of your resume to hr@vinsysinfo.com along with the rate / salary and best time to reach you.
Client: Wisconsin Department of Workforce Development Worker s Compensation Division
Number of Positions: 1
Location: Madison, WI 53703(Onsite) Position Summary
The Worker s Compensation Specialist will review and resolve healthcare cost disputes involving medical services and pharmacy charges related to workplace injuries. The position will also prepare treatment-necessity disputes for expert review and provide technical and administrative support concerning workers compensation claims and procedures.
Key Responsibilities
Client: Wisconsin Department of Workforce Development Worker s Compensation Division
Number of Positions: 1
Location: Madison, WI 53703(Onsite) Position Summary
The Worker s Compensation Specialist will review and resolve healthcare cost disputes involving medical services and pharmacy charges related to workplace injuries. The position will also prepare treatment-necessity disputes for expert review and provide technical and administrative support concerning workers compensation claims and procedures.
Key Responsibilities
- Review and analyze medical cost disputes for completeness.
- Verify that disputes are associated with active workers compensation claims.
- Enter and maintain dispute information in claims databases, health-cost systems, and Excel.
- Obtain supporting information from employers, insurance carriers, injured employees, attorneys, and medical providers.
- Use healthcare fee databases to identify certified fee information.
- Calculate appropriate medical payment amounts.
- Draft orders directing insurance carriers or employers to pay certified amounts.
- Research pharmacy fee-schedule disputes and prepare final orders.
- Apply applicable Wisconsin statutes, administrative rules, and agency procedures.
- Review treatment-necessity disputes and determine whether cases are ready for expert review.
- Compile medical and claim documentation for submission to private medical experts.
- Respond to questions from injured workers, employers, insurance carriers, attorneys, and healthcare providers.
- Conduct informal conferences and interviews with disputing parties.
- Maintain accurate case-status documentation and recommend process improvements.
- Effective written and verbal communication skills.
- Customer service experience.
- Investigative and fact-finding skills.
- Knowledge of dispute-resolution and conflict-resolution techniques.
- Strong analytical and problem-solving abilities.
- Knowledge of medical terminology.
- Familiarity with healthcare procedure coding.
- Proficiency with computers, databases, imaging systems, and Microsoft Excel.
- Basic mathematical skills for payment calculations.
- Ability to read, interpret, and apply statutes and administrative rules.
- Ability to review medical reports, claim documents, and factual materials.
- Ability to make objective decisions in complex or disputed situations.
- Ability to work effectively with coworkers, agency personnel, and members of the public.