Workers’ Compensation Resolution Specialist I

Gemini Legal Support Inc • West Covina, CA

1d • Hybrid

About The Position

The Workers’ Compensation (WC) Resolution Specialist I’s primary responsibility is to manage and resolve accounts/cases associated with workers' compensation claims in outstanding AR greater than 1 year. This role demands a strong understanding of workers' compensation regulations, excellent negotiation skills, and the ability to collaborate with multiple stakeholders. An additional objective is analyzing and preparing cases for the possibility of litigation. This position includes compliance with HIPAA, state and federal document security regulations. Specialists receive advanced training in workers’ compensation laws, regulations, and copy service fee schedules related to all aspects of billing, collections, objections, and the regulatory landscape related to specifically copy service.

Requirements

• High School diploma or equivalent is required
• 1-3 years of experience in the workers’ compensation field required
• Typing speed of at least 35 WPM with 90% accuracy
• Understanding of workers' compensation regulations
• Ability to collaborate with multiple stakeholders
• Comprehensive skills in process writing and flow chart mapping
• Ability to effectively negotiate
• Excellent verbal and written communication skills, including proof-reading, syntax, and grammar
• General computation skills, including the use of a calculator
• Proficient using a computer, business phone, office software, video conferencing, and other computer programs including Google Workplace (Docs, Sheets, Calendar, Gmail, etc.) and Microsoft applications
• Ability to complete data entry with a high level of accuracy
• Sitting for at least one hour at a time (total: 4-6 hours/day)
• Keyboarding for extended periods of time (total: 4-6 hours/day)
• Using a phone with or without a headset for extended periods (total: 3-5 hours/day)

Responsibilities

• Review, assess, and analyze cases associated with workers' compensation claims to determine their validity and accuracy
• Conduct comprehensive research and gather necessary documentation to support negotiations and resolutions
• Negotiate with claims adjusters, lien resolution specialists, defense attorneys, and other relevant parties, to reach fair and reasonable settlements
• Ensure compliance with all relevant workers' compensation laws, regulations, and guidelines in lien resolution activities
• Maintain effective communication with various stakeholders, including claims adjusters, attorneys, lien units, clients, and internal stakeholders to update them on the progress of case resolution
• Maintain detailed records of all resolution activities, including agreements, payments, and any relevant correspondence
• Create and maintain detailed analysis of cases in preparation of litigation
• Record keeping of payment pursuant to settlement agreements and correspondence with a guarantee of payment
• Handle any disputes or conflicts related to lien resolution in a professional and diplomatic manner
• Identify opportunities to minimize costs associated with resolution of cases while upholding legal and ethical standards
• Stay updated on changes in workers' compensation laws and regulations, and attend training sessions or workshops as necessary
• May handle collections of the Voucher and/or Civil AR, requiring basic workers’ compensation knowledge related to vouchers
• Other duties as required

Benefits

• Comprehensive medical, dental, and vision coverage
• Generous paid time off, including PTO, sick leave, volunteer time, and paid holidays
• 401(k) plan with company match
• Tuition reimbursement program
• Employee Assistance Program and legal assistance benefit
• Company-paid annual charitable donation in your name
• Employee recognition program

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: High school or GED