Claims Reviewer I

State of Maryland•Baltimore City, MD

2d•Onsite

About The Position

Imagine a career in public service. At WCC, we are collaborative and team oriented, innovative in our approach, and passionate about our work. We thrive on initiative, creativity and challenges to the status quo. Our employees are valued and empowered. We are proud of our achievements and consider excellence a continuous journey…not a destination end point. If you've got the right stuff and a passion for your work, come journey with us. OUR MISSION The Maryland Workers' Compensation Commission seeks to secure the equitable and timely administration of the provisions of the Maryland Workers' Compensation law on behalf of its customer, the injured workers and their employers, by providing an efficient forum for the resolution of individual claims. OUR VISION The Workers' Compensation Commission envisions a state wherein injured workers and employers are empowered to create an equitable partnership to facilitate prompt and fair resolution of workers' compensation matters. ABOUT US Together we profoundly touch the lives of so many people and have enormous responsibility to the community by fulfilling our mission of securing equitable and timely administration of the law. The Commission continues to provide services to our constituent partners at a level rarely met throughout the United States. The professionalism, work ethic, and technological acumen manifest in our operations allows us to smoothly and effectively manage the challenges which invariably arise. Every division within the agency plays a vital role in keeping us in the forefront nationally... ARE YOU READY TO MAKE A MEANINGFUL DIFFERENCE IN YOUR COMMUNITY AND PURSUE YOUR CAREER PASSION WITH A NATIONALLY RECOGNIZED LEADER? GRADE GRADE 09 This position is eligible for a non-competitive promotion to a Claims reviewer II (grade 10 - with growth to $66,759) after satisfactorily completing a training program and performing the full range of duties and responsibilities of the classification under general supervision. LOCATION OF POSITION 10 East Baltimore Street, Baltimore, Maryland 21202 Main Purpose of Job To review, analyze, investigate, and process Workers’ Compensation claims and related documents, and route action documents sent to claims queues to appropriate parties via CompHub in an equitable and timely manner which also includes hearing related findings per the established rules & procedures of the Workers' Compensation law.

Requirements

Graduation from an accredited high school or possession of a high school equivalency certificate.
One year of clerical experience handling compensation claims or three years of general clerical experience.
Candidates may substitute additional general clerical experience on a year-for-year basis for the required education.
Candidates may substitute U.S. Armed Forces military service experience as a non-commissioned officer in Workers’ Compensation Claims Examining classifications or Workers’ Compensation Claims Examining specialty codes in the Legal and Kindred field of work on a year-for-year basis for the required experience.
6 months experience working with claims

Nice To Haves

6 months experience in workers' compensation laws and regulations
1 year experience with workers’ compensation claims
1 year experience working with insurance companies/agencies
Intermediate skills in Microsoft Office (Word, Excel, Outlook and PowerPoint)

Responsibilities

The main purpose of the Claims Reviewer is to review, analyze, investigate, and process Workers' Compensation claims and related documents, and route action documents sent to claims queues to appropriate parties via CompHub in an equitable and timely manner which also includes hearing related findings per the established rules and procedures of the Workers' Compensation law.
Responsible for reviewing and processing claim related documents received in the claims queues including wages statements, enter/strike appearances via CompHub in accordance with the established procedures.
Reviewing and processing all hearing related documents received in claims queues CompHub, such as emergency hearings, rehearing, postponements, other motions and petitions, withdraw issues, etc. in accordance with the established procedures.
Reviewing and processing request for hearings (Issues) received in the CompHub queues and entering the information into the CompHub in accordance with the established procedures.
Responsible for reviewing, coding, and processing Workers Compensation claims (regular, death, and medical).
Responsible for processing all claims (regular, death and medical) through CompHub for generation of copies to all essential parties.
Monitor undeliverable mail-notifying parties and maintaining current business names and addresses.
Responsible for handling incoming and outgoing telephone inquiries from employers, insurance companies, attorneys, and claimants that require further clarification or additional information for processing documents received in accordance with the established procedures.
Providing backup coverage for the Public Service Division for incoming inquiries.
Analyzing, reviewing and processing claim related insurance corrections.
Responsible for reviewing and processing award order corrections in accordance with the established procedures.
Reviewing temporary total (TT) and compensation deferred (CD) orders for insured & non-insured claims and entering the information in CompHub in accordance with the established procedures.
Reviewing and processing C-40 responses, through analyzing claims and entering required data into CompHub.