Orthopedic Workers' Comp Claims Specialist

Boston Medical Center (BMC); Boston (MA); On-site; USD 35,000 - 51,000; Full time

Job summary

Boston Medical Center is seeking an Orthopedic Surgery Workers Compensation Specialist to support orthopedic patients with workers' compensation needs. This full-time role handles clerical tasks, data processing, and liaison duties across patients, providers, insurers, and attorneys.

Responsibilities include managing the internal workers' compensation program, processing claims through evaluation to discharge, coordinating appointments and surgeries, and maintaining weekly and monthly case

Qualifications

• Associates degree in a business/legal field required; Bachelor's preferred.
• Minimum three years clerical and insurance management experience.
• At least one year workers' compensation adjuster or case manager experience.

Responsibilities

• Developing, maintaining, and managing our internal workers' comp program.
• Investigating and processing workers' compensation claims through evaluation to discharge.
• Communicating with employees, managers, insurers, medical providers, and attorneys about workers' comp issues.
• Responding to claim investigations, settlements, and litigations with the Billing Director.
• Closing the communication loop regarding claims processing, status, and denials.
• Assisting patients with reporting workplace injuries promptly.
• Scheduling and managing appointments, IMEs, and assisting with depositions/court appearances.
• Updating the internal workers compensation database weekly and producing monthly active case reports.
• Handling communications of claims updates across all parties.
• Working within workers' compensation laws, rules, and requirements for accommodations and return-to-work.
• Obtain verification, pre-certification, pre-authorization and authorization for scheduled tests/procedures.
• Assist with scheduling surgeries, imaging, pre-Op clearance, referrals.
• Contact insurance or legal representatives to confirm client information and appointments.
• Act as the main contact for all injured patients with active WC cases.
• Liaise between physicians, the insurance carrier, and legal representatives.
• Inform patients about appointments and surgery approval status.
• Communicate promptly with attorneys, adjusters, physicians, patients and staff.
• Adhere to BMC’s RESPECT behavioral standards.

Skills

Workers' compensation

Communication skills

Organizational skills

Microsoft Office

Data reporting

Education

Associate degree in Business/Legal related field

Bachelor's degree preferred

Job description

Boston Medical Center is seeking an Orthopedic Surgery Workers Compensation Specialist to support orthopedic patients with workers' compensation needs. This full-time role handles clerical tasks, data processing, and liaison duties across patients, providers, insurers, and attorneys.

Responsibilities include managing the internal workers' compensation program, processing claims through evaluation to discharge, coordinating appointments and surgeries, and maintaining weekly and monthly case