JOB SUMMARY:
Under the direction of the Workers’ Compensation Supervisor, the WC Specialist serves as a liaison between injured workers, physicians, employers, and insurance carriers. This role coordinates return-to-work (RTW) activities and provides comprehensive case management services to ensure timely RTW or continued service on full or partial duty. The specialist also supports accurate billing, insurance verification, and patient data management to ensure a smooth reimbursement process.
SCHEDULE:
Monday - Friday 8:00am - 4:30pm
No weekends, holidays, nights
TRAVEL:
Position is based in York, PA - in office 3-4 days per week; Remote work one day per week once FULLY trained
Weekly travel to West York office one day per week
QUALIFICATIONS AND EDUCATION:
- High school diploma or GED and at least 2 years of experience in a related fiscal/admissions/registration function, or associate degree and 1 year of experience, or an equivalent combination of education and experience.
- Knowledge of medical terminology, third-party health care coverage, and general knowledge of Workers’ Compensation law.
- Proficiency in electronic medical records (EMRs) and Microsoft Office Suite (e.g., Word, Excel, Outlook) required.
- Strong interpersonal, organizational, and communication skills.
- Ability to remain professional and courteous when dealing with sensitive issues and stressful circumstances.
- Effective problem-solving and independent decision-making skills.
- Prior experience with personal computers and office equipment.
- Knowledge and skills necessary to interact appropriately with patients of all ages and provide care as described in departmental policies and procedures.
ESSENTIAL DUTIES AND RESPONSIBILITIES:
- Facilitate case management for injured workers treated by OSS Health.
- Receive claims, confirm policy coverage, and acknowledge claims.
- Maintain communication with claims adjusters and all involved parties.
- Ensure compliance with client policies and statutory regulations.
- Coordinate RTW efforts with physicians, employers, and insurers.
- Obtain out-of-state treatment authorizations as needed.
- Maintain accurate and up-to-date documentation on all claims.
- Communicate effectively throughout the case lifecycle.
- Exercise sound, independent judgment in decision-making.
- Review complex cases, including second opinions and medical evaluations; collaborate with providers and medical team.
- Facilitate interdisciplinary discussions and recommend actions to resolve claim concerns.
- Collaborate with management on program development and evaluation.
- Initiate cost control and quality improvement processes related to customer service.
- Respond to client concerns in a timely and appropriate manner.
- Update patient demographic, employer and insurance information accurately in the system as necessary.
- Verify insurance benefit information with carriers.
- Interact with ancillary departments to resolve reimbursement issues and take appropriate action to ensure successful billing.
- Perform duties in accordance with system-wide competencies and behaviors.
- Participate in on-site company tours as required to support case management and return-to-work coordination.
SUPERVISORY RESPONSIBILITIES:
No direct reports
LANGUAGE SKILLS:
Must possess the ability to communicate clearly and effectively in English, both verbally and in writing, with staff, peers, healthcare providers, and the public.
PHYSICAL DEMANDS:
Light physical effort; some standing, walking, bending, reaching, stooping; manual dexterity to operate keyboard and other equipment.
- Work requires the ability to stoop, bend, reach, and grab with arms and hands; manual dexterity.
- Work requires the ability to lift/carry objects periodically.
- No lifting of objects weighing more than 5 pounds on a regular basis.
- Work requires the ability to sit or stand for up to 7.5 or more hours at a time.
- Work requires sufficient auditory and visual acuity to interact with others.
Travel:
- Travel to off-site locations is required on a weekly basis.
WORK ENVIRONMENT:
Climate controlled environment with occasional periods of being outside.
The above statements reflect the general duties considered necessary to describe the principle functions of the job as identified, and shall not be considered as a detailed description of all work requirements that may be inherent in the position.