Senior Workers' Compensation Analyst Remote

Harris Computer; Tennessee; Ibrido; USD 70.000 - 100.000; Tempo pieno

Descrizione del lavoro

Harris Computer is seeking a Senior Workers' Compensation Specialist, Complex Claims, to verify WC carrier and claim information, manage billing, denials and appeals, and work autonomously on WC and No-Fault accounts. The role involves negotiating with carriers, adjusting with leaders to improve workflows, and mentoring teammates.

The ideal candidate understands orthopedic and pain management billing, state WC guidelines, and major insurance carriers.

Competenze

• Experience with workers' compensation and No-Fault billing.
• Knowledge of orthopedic and pain management billing, state WC guidelines and major insurance carriers.
• Ability to mentor and train team members and handle complex/escalated accounts.
• Ability to work autonomously and contribute to SOPs and workflow improvements.

Mansioni

• Verifies WC carrier and claim information during billing and posting.
• Obtains authorizations and referrals for scheduled services.
• Submits claims and prepares appeals within deadlines.
• Documents trends and denials to improve reimbursement and collections.
• Leads process improvements with leadership to streamline workflows.
• Mentors junior staff and serves as expert on WC and No-Fault billing.
• Posts payments and maintains payment records.

Conoscenze

Workers' compensation billing

No-Fault billing

Negotiation with carriers

Mentoring/leadership

Process improvement

Descrizione del lavoro

Job Summary

The Senior Workers' Compensation Specialist, Complex Claims, verifies workers' compensation (WC) carrier and claim information, then manages billing, follow-up, denials and appeals through to payment. In this senior-level role, the Specialist works WC and No-Fault accounts autonomously, negotiates with carriers and adjusters, and flags trends that affect reimbursement. The Specialist also works with leadership and their direct manager to improve workflows and streamline operations. The ideal candidate knows orthopedic and pain management billing, state WC guidelines and major insurance carriers.

Essential Functions

• Verifies workers' compensation carrier and claim information before and during billing, including:
• Confirming the correct WC carrier, claim number, date of injury, employer and adjuster contact details.
• Confirming claim status (accepted, pending, denied or closed) and the accepted body parts / injuries.
• Obtaining and documenting authorizations and referrals for scheduled services.
• Using carrier phone lines, adjusters, employer contacts and web portals, and noting all findings in the patient account.
• Initiates contact with WC insurance carriers, adjusters and web portals on all outstanding bills, updating accounts and noting them as worked.
• Prepares and submits claims, verifying accuracy and correcting errors before submission.
• Prepares appeals with all required documentation and submits them to the insurance carrier within filing deadlines.
• Corrects inaccurate demographic and insurance information for insurance and patient billing.
• Alerts the team and managers to trends, recurring denials or billing issues as they arise.
• Works with leadership and their direct manager to find process gaps, streamline workflows and improve reimbursement and collection outcomes, including creating, updating and maintaining Standard Operating Procedures (SOPs) for workers' compensation and No-Fault processes.
• Mentors and trains less-experienced team members, and serves as the go-to expert on workers' compensation and No-Fault billing.
• Takes ownership of complex and escalated accounts through to resolution, using independent judgment within department policies.
• Posts payments and documents payment records and issues promptly.
• Scans and uploads documents and medical records for claims processing and medical records requests.

At Harris, we believe great people build great software. We offer an environment where employees are empowered to make a real impact, grow their skills, and shape their careers. Our teams enjoy a supportive, award‑winning culture, a casual and collaborative workplace, and opportunities to learn from a diverse group of businesses and industries. We are financially strong and proudly part of Constellation Software Inc. (CSI), the largest software company in Canada, providing long‑term stability alongside entrepreneurial autonomy. In addition to a competitive compensation and benefits package, we offer meaningful perks, flexibility, and—most importantly—a culture that values people, curiosity, and having fun while doing great work. Follow us on LinkedIn to learn more about our culture, values, and career opportunities.

Harris is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, or protected veteran status and will not be discriminated against on the basis of disability. Applicants who require a reasonable accommodation due to a disability may contact us by email at [e-mail]. Accommodation requests may be made at any time. This email address is dedicated solely to accommodation requests and cannot be used to inquire about application status.

Know Your Rights Poster EO 13496: Notification of Employee Rights under Federal Labor Laws Our commitment to fair and equitable hiring. As part of our recruitment process, we use artificial intelligence (AI) tools during the initial screening phase to help identify candidates whose qualifications most closely align with the requirements of the role. This technology supports efficiency and consistency in the early stages, but it never replaces human judgement. All subsequent evaluations and final hiring decisions are made by our recruitment professionals. AI does not make final hiring decisions.