Orthopedic Surgery Workers Compensation Specialist

Boston Medical Center (BMC); Boston (MA); On-site; USD 34,440 - 50,971; Full time

Job summary

Boston Medical Center seeks an Orthopedic Surgery Workers Compensation Specialist to support clerical and administrative tasks for workers' compensation cases within the Orthopedic Clinic. You will process claims, generate reports, and coordinate communications among patients, claim representatives, and providers.

The role requires at least three years of clerical and insurance management experience, with preferred workers' comp adjuster experience.

Qualifications

• Associates degree required; Bachelor’s degree preferred.
• Minimum three years of clerical and insurance management experience.
• At least one year of workers' compensation adjuster or case manager experience.
• Experience in an Orthopedic clinical setting is a plus; Workers’ Compensation certification is preferred but not required.
• Knowledge of workers’ compensation program administration and applicable laws.
• Strong communication and organizational skills; ability to interpret and disseminate information.

Responsibilities

• Develop, maintain, and manage the internal workers' comp program.
• Investigate and process workers' comp claims from initial evaluation through discharge.
• Communicate with employees, managers, insurers, medical providers, surgeons, attorneys, and management.
• Coordinate with the Billing Director on investigations, settlements, and litigation.
• Maintain and close the communication loop on claims status and denials.

Skills

Workers' Comp knowledge

Communication

Organizational skills

Spreadsheet skills

Accounting basics

Interpersonal skills

Project coordination

Independent work

Customer service

Education

Associates degree in a Business/Legal related field

Job description

Position Summary

Under direct supervision of the Operations Supervisor, the WCS provides clerical and administrative support to the orthopedic patients with musculoskeletal work‑related injuries covered by “worker’s compensation” insurance. The WCS processes data, generates routine reports and provides direct and timely support to claim representatives and patients. Additionally, the WCS maintains office records, appointments, and calendars. Other duties include but is not limited to, answering telephones, facilitating communications between the WC stakeholders, assisting with peer reviews, filing, mail processing, document scanning, preparing and handling letters and medicolegal document(s), and surgical pre‑authorizations.

Position: Orthopedic Surgery Workers Compensation Specialist

Department: Orthopedic Clinic

Schedule: Full Time

Essential Responsibilities / Duties

• Developing, maintaining, and managing our internal workers' comp program
• Investigating and processing workers' compensation claims from the initial evaluation to surgical and discharge phases.
• Communicating with employees, managers, insurance carriers, medical providers, surgeons, attorneys, legal representatives, and upper management regarding workers comp issues
• In collaboration with our Billing Director, responding to claim investigations, settlements, and litigations.
• Keeping up-to-date with and closing the communication loop regarding claims processing, status, and denials
• Assisting our patients with reporting workplace injuries in a timely manner
• Scheduling and managing appointments (routine follow-ups, IMEs, etc.), and assisting the Medical Providers with scheduling depositions, court appearances, etc.
• Updating our internal workers compensation database (weekly), and producing monthly updated active case reports
• Dealing with claim investigations, settlements, and litigation issues.
• Handling communication of claims updates across all parties.
• Working within the various Workers Compensation laws, rules, and requirements for common requests such as accommodations, restrictions, and return‑to‑work.
• Obtain verification, pre-certification, pre‑authorization and authorization for scheduled tests and procedures as needed
• Assist with scheduling: surgeries, appointments, imaging-diagnostics (MRI, CT scan, X-ray, EMG/NCS, Bone Density, etc.), pre‑Op clearance, referrals, etc.
• Contact the insurance or legal representative/attorney for case information to confirm client Information and appointments
• Act as the main point of contact for all injured patients with active WC cases
• Act as the liaison between the physician(s), the insurance carrier, and the legal representatives.
• Communicate and inform patients regarding appointments and/or surgeries approval status
• Able to communicate promptly and clearly with attorneys, adjusters, physicians, patients and involved staff.
• Must adhere to all of BMC’s RESPECT behavioral standards.

Education

JOB REQUIREMENTS

• Associates degree in a Business/Legal related field. Bachelors preferred.

Experience

• The job requires a minimum of three years of clerical and insurance management experience. In addition the ideal candidate will also possess at least one year work comp adjuster or case manager experience.
• Experience in the Orthopedic clinical setting a plus. Workers Compensation Analyst certification preferred but not required.

Knowledge And Skills

• Knowledge of administration of workers’ compensation program and applicable laws
• Ability to interpret, explain and disseminate information to individuals and groups
• Effective communication and interpersonal skills
• Organizational and communication skills.
• Ability to develop spreadsheets, databases, PowerPoint and Word documents
• Knowledge of basic accounting principles.
• Ability to work well with external parties as well as co‑workers.
• Strong critical thinking and analytical abilities.
• Ability to effectively present information in one‑on‑one and small group situations.
• Strong organizational analytical and problem solving skills.
• The ability to coordinate multiple projects with varying and changing priorities and to meet deadlines.
• Have the ability to work independently and collaboratively and possess strong customer-service

Compensation Range

$25.48- $37.02

This range offers an estimate based on the minimum job qualifications. However, our approach to determining base pay is comprehensive, and a broad range of factors is considered when making an offer. This includes education, experience, skills, and certifications/licensures as they directly relate to position requirements; as well as business/organizational needs, internal equity, and market‑competitiveness. In addition, BMCHS offers generous total compensation that includes, but is not limited to, benefits (medical, dental, vision, pharmacy), discretionary annual bonuses and merit increases, Flexible Spending Accounts, 403(b) savings matches, paid time off, career advancement opportunities, and resources to support employee and family well‑being.

NOTE

This range is based on Boston‑area data, and is subject to modification based on geographic location.

Equal Opportunity Employer/Disabled/Veterans

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