Workers' Compensation Specialist - Le Mars - Wells Enterprises

Description

Under general direction, ensures the timely processing and management of Workers Compensation claims. Evaluates information to determine accuracy, completeness, and proper submission as the primary point of contact for internal and external business partners.

• Gathers claim information and submits claims to the Third-Party Administrator (TPA) in a timely manner, ensuring compliance with established guidelines.
• Provides supplementary claim information, including wages, return-to-work status, medical provider details, incident investigation findings, and other relevant data to the TPA.
• Attends quarterly file review meetings and other claim-related meetings as required, facilitating collaboration and knowledge sharing among team members.
• Manages discovery requests for litigated claims, ensuring efficient and effective response to legal inquiries.
• Runs claim reports and conducts analysis for both internal and external parties as necessary, providing actionable insights and recommendations.
• Oversees the pharmacy program, ensuring seamless coordination with medical providers and vendors.
• Manages employee mileage reimbursement and appointment scheduling, streamlining administrative processes and reducing operational complexities.