Urgent Need Program Assistant 2 / Worker’s Compensation Specialist - Madison, WI (Onsite)

Vinsys Information Technology Inc; Madison (WI); On-site; USD 25,000 - 39,000; Full time

Job summary

Wisconsin Department of Workforce Development Worker s Compensation Division is seeking a temporary Program Assistant 2 to support healthcare cost disputes and treatment-necessity reviews related to workers’ compensation claims. The role involves reviewing medical cost disputes, maintaining case documentation, and communicating with injured workers, employers, insurers, attorneys, and healthcare providers.

Proficiency with Excel and claims databases is preferred, along with strong analytical and

Qualifications

• Effective written and verbal communication with diverse stakeholders.
• Familiarity with dispute-resolution techniques and decision making.
• Ability to read, interpret, and apply statutes and agency rules.
• Experience with medical terminology and healthcare coding is a plus.

Responsibilities

• Review and analyze healthcare cost disputes for completeness.
• Verify disputes relate to active workers’ compensation claims.
• Enter and maintain dispute information in claims databases and health-cost systems.
• Obtain supporting information from employers, carriers, and medical providers.
• Calculate appropriate medical payment amounts and draft orders.

Skills

Communication skills

Customer service

Investigation

Analytical skills

Reading statutes

Medical terminology

Data entry

Team collaboration

Tools

Excel

Databases

Claims databases

Job description

We are seeking one qualified candidate for a temporary Program Assistant 2, functioning as a Worker s Compensation Specialist Health Cost Disputes, supporting the Wisconsin Department of Workforce Development s Worker s Compensation Division.

Client:

Wisconsin Department of Workforce Development Worker s Compensation Division

Number of Positions:

1

Location:

Madison, WI 53703(Onsite)

Position Summary

The Worker s Compensation Specialist will review and resolve healthcare cost disputes involving medical services and pharmacy charges related to workplace injuries. The position will also prepare treatment-necessity disputes for expert review and provide technical and administrative support concerning workers compensation claims and procedures.

Key Responsibilities

• Review and analyze medical cost disputes for completeness.
• Verify that disputes are associated with active workers compensation claims.
• Enter and maintain dispute information in claims databases, health-cost systems, and Excel.
• Obtain supporting information from employers, insurance carriers, injured employees, attorneys, and medical providers.
• Use healthcare fee databases to identify certified fee information.
• Calculate appropriate medical payment amounts.
• Draft orders directing insurance carriers or employers to pay certified amounts.
• Research pharmacy fee-schedule disputes and prepare final orders.
• Apply applicable Wisconsin statutes, administrative rules, and agency procedures.
• Review treatment-necessity disputes and determine whether cases are ready for expert review.
• Compile medical and claim documentation for submission to private medical experts.
• Respond to questions from injured workers, employers, insurance carriers, attorneys, and healthcare providers.
• Conduct informal conferences and interviews with disputing parties.
• Maintain accurate case-status documentation and recommend process improvements.

Required Knowledge and Skills

• Effective written and verbal communication skills.
• Customer service experience.
• Investigative and fact-finding skills.
• Knowledge of dispute-resolution and conflict-resolution techniques.
• Strong analytical and problem-solving abilities.
• Knowledge of medical terminology.
• Familiarity with healthcare procedure coding.
• Proficiency with computers, databases, imaging systems, and Microsoft Excel.
• Basic mathematical skills for payment calculations.
• Ability to read, interpret, and apply statutes and administrative rules.
• Ability to review medical reports, claim documents, and factual materials.
• Ability to make objective decisions in complex or disputed situations.
• Ability to work effectively with coworkers, agency personnel, and members of the public.