Job Description

About the Role:

Our insurance carrier client is seeking an experienced Workers' Compensation Medical Payment Specialist to join their Claims Operations team on a temporary remote assignment. This individual will play a critical role in ensuring the timely, accurate, and compliant processing of medical payments for Workers' Compensation claims while serving as a key resource for claims professionals and internal stakeholders.

The ideal candidate will possess strong knowledge of Workers' Compensation medical billing, state fee schedules, bill review processes, and payment auditing. Experience working with insurance carriers, TPAs, or bill review vendors is highly preferred.

Compensation:

• $40.00 - $50.00/hr.
• Opportunity to work with a reputable insurance carrier known for a collaborative and supportive culture
• Comprehensive benefits package including medical, dental, vision, and 401(k).
• Opportunities for career growth within a stable and respected insurance organization.

Responsibilities

• Oversee the accurate processing of Workers' Compensation medical payments in accordance with applicable state fee schedules and regulatory requirements.
• Review, audit, and reconcile medical bills to ensure payment accuracy and compliance.
• Partner with bill review vendors to monitor performance, resolve discrepancies, and maintain contractual compliance.
• Investigate and resolve payment issues, duplicate payments, billing discrepancies, and reimbursement errors.
• Evaluate daily EDI transactions for both individual and bulk medical bill payments.
• Review Explanation of Review (EOR) documentation to verify payment accuracy, tax identification information, duplicate payments, and processing errors.
• Collaborate with Claims professionals to improve medical bill processing workflows and resolve complex payment issues.
• Submit electronic reconsideration requests to bill review vendors when appropriate.
• Maintain accurate documentation and data within claims management systems.
• Respond promptly to medical billing inquiries from internal and external stakeholders.
• Assist with reporting, quality assurance initiatives, and process improvement efforts.
• Perform additional duties as assigned.

Requirements

• Minimum 2 years of experience handling Workers' Compensation medical billing, medical payment processing, bill review, or medical pricing.
• Bachelor's degree preferred. Relevant insurance industry experience may be considered in lieu of education.
• Experience working for an insurance carrier, TPA, or medical bill review vendor preferred.
• Knowledge of Workers' Compensation claims processes and medical terminology.
• Strong analytical and problem-solving skills with exceptional attention to detail.
• Ability to prioritize multiple assignments while meeting deadlines in a fast-paced environment.
• Excellent verbal and written communication skills.
• Strong customer service mindset with the ability to collaborate across departments.
• Proficiency with Microsoft Office Suite and insurance claims management systems.

Disclaimer: Please note that this job description may not cover all duties, responsibilities, or aspects of the role, and it is subject to modification at the employer's discretion.

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