Duties:

• Workflow and Training Coordination
  • Assists in the review and development of section workflow efficiencies.
  • Organizes, develops, and assists in the implementation of training sessions.
  • Is responsible for coordination of WC claims-related training sessions with internal or external trainers/consultants.
  • Works with insureds, clients, vendors, and consultants with regard to the services provided by and necessary to the section.
  • Continually analyzes and assesses section workflow processes/procedures. Generates possible solutions and proposes recommendations to improve the handling efficiency in processing/documentation.
• Reporting and Documentation
  • Prepares accurate reserve/payment history summaries for reinsurance audits.
  • Participates in the preparation of responses to inquiries from third parties, including but not limited to audit inquiries.
  • Participates in the defense of actions taken in responding to inquiries.
  • Produces confidential statistical data in spreadsheet format and compiles in specified daily, monthly, quarterly, and ad hoc production reports (caseload, diaries, late reserves, etc.) utilizing systems and other available Business Intelligence tools.
  • Creates graphs and charts using production information for data analysis by leadership.
  • Coordinates client claim review meetings including generating claim list, distributing list to adjusters, collecting claim status reports, and creating binders for clients.
  • Assists supervisor by documenting and updating section procedures in SOP format and saves in SharePoint.
  • Enters timely, clear, and concise notes on applicable computer claim handling system to document all claims-related activities (e.g., generating final WC-3 reports, payment issuance, telephone call with providers, etc.)
• Meetings and Communication
  • Attends weekly staff meetings and records meeting minutes.
  • Assists in composing and compiling basic letters, memos, and other communication media as requested.
  • Assists supervisor with medical provider and vendor inquiries regarding outstanding bill payment or non-claim status.
  • Maintains and updates section logs. Keeps supervisor apprised of any outstanding reports.
• Financial and Data Management
  • Assists supervisor with medical bill review, claim payments, and file closings by preparing and submitting accurate financial reports to the State.
  • Assists supervisor with check issuance processes. Investigates, tracks, and monitors duplicate payments, voided checks, and claim overpayments. Compiles data for supervisor review.
  • Maintains and updates the list of Reinsurance Treaties and retention levels and stores in SharePoint.
  • Reviews and distributes monthly reports to adjusters. Monitors corrections and submissions to NCCI.
  • Reviews reports and makes appropriate corrections on NCCI website; while reviewing claims data.
  • Serves as a resource to all section personnel and provides training on coding, payment, and processing as appropriate.
  • Is familiar with Medicare and DCI coding guidelines and serves as a resource to all adjusting staff members on coding expectations. Assists supervisor with error monitoring and corrections.

Education/Experience:

• High school diploma or general education degree (GED) required; and College degree with credits in insurance and/or medical related subjects preferred.
• Minimum 1 year workers’ comp or insurance related work experience preferred.  
• Continuing education in insurance and job related issues and subjects required.
• Equivalent combination of education and job-related experience will be considered.

Certifications/Licenses:

• Valid Hawaii Driver’s license and use of own vehicle preferred.

Salary Range: $24.00 To $31.00 Hourly