Workers Compensation Claims Specialist - Remote

Overview

This is a remote position.

Position Overview

The Workers Compensation Claims Specialist is responsible for the being the liaison between the Aveanna Field Staff and the third party administrator. This role will require investigation of claims and insurance that our third party administrator is managing the claims in an effect manner. This position will resolve claims according to Best Practices and within authority limits by following established protocols to ensure that claims are handled in the most efficient, effective way while delivering excellent customer claims service.

Essential Job Functions

Investigating, reviewing, evaluating, and administering workers' compensation claims

Reviewing medical reports

Setting reserves

Filing documentation

Reviewing and approving medical bills for payment

Reviewing accident and injury reports

Interviewing and correspond with claimants, witnesses, attorneys, and physicians

Approving claims or recommending denial

Representing Aveanna at various workers' compensation and industrial leave claims actions and hearings

Perform other duties as assigned

Requirements

High School Diploma and 5 years or more experience in Claims and Litigation OR a Bachelor’s Degree and 4 years’ experience in Claims and Litigation

Knowledge of claims handling and legal statutes and procedures

Customer service experience

Workers Comp experience in California, Texas, and Pennsylvania and non-subscriber claim experience highly preferred

Other Skills/Abilities

Attention to detail

Time Management

Effective problem-solving and conflict resolution

Good organization and communication skills

Physical Requirements

Must be able to speak, write, read and understand English

Occasional lifting, carrying, pushing and pulling of 25 pounds

Prolonged sitting, walking, standing, bending, kneeling, reaching, twisting

Must be able to sit and climb stairs

Must have visual and hearing acuity

Must have strong sense of smell and touch

Environment

Performs duties in an office environment during agency operating hours

Must be able to function in a wide variety of environments which may involve exposure to allergens and other various conditions

Other Duties

Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice.

Vaccination Requirement

As an employer accepting Medicare and Medicaid funds, employees must comply with all health-related requirements in all relevant jurisdictions, including required vaccinations and testing, subject to exemptions for medical or religious reasons as appropriate.

Headhunters and recruitment agencies may not submit resumes/CVs through this website or directly to managers. Aveanna does not accept unsolicited headhunter and agency resumes, and will not pay fees to any third-party agency or company that does not have a signed agreement with Aveanna.