Workers' Compensation Analyst
Bottom Line Systems - Crescent Springs, KY

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Position Summary : Primarily responsible for thorough review of managed care contracts, state workers’ compensation regulations and comparison of such against healthcare claims to identify underpayments for the assigned clients.

General Purpose: Client relations; problem resolution; critical thinking; auditing; relationship building

Essential Duties and Responsibilities:
    • Provide feedback to Manager regarding updates, issues and needs
    • Review insurance contracts to gain thorough understanding of payment methodologies Examine claims and calculate reimbursement based on contract terms to determine accuracy of payment through use of various reports and supporting documentation
    • Contact insurance company to obtain missing information, explain and resolve underpayments and arrange for payment or adjustment processing on behalf of client
    • Prepare and submit correspondence such as letters, emails, online inquiries, appeals, adjustments, reports and payment posting
    • Maintain regular contact with necessary parties regarding claims status including payors, clients, managers and other BLS personnel
    • Build strong, lasting relationships with clients, payors and BLS personnel
    • Research and interpret workers’ compensation legislation and contracts in order to understand policies, procedures and workers’ compensation laws applicable to departmental clients
    • Review insurance contracts to gain thorough understanding of payment methodologies
    • Examine claims and calculate reimbursement based on contract terms to determine accuracy of payment through use of various reports and supporting documentation
    • Contact insurance company, employer or workers’ compensation board to obtain missing information, explain and resolve underpayments and arrange for payment or adjustment processing on behalf of client
    • Prepare and submit correspondence such as letters, emails, online inquiries, appeals, adjustments, reports and payment posting
    • Maintain regular contact with necessary parties regarding claims status including payors, clients, managers, and other BLS personnel
    • Attend client, department and company meetings
    • Comply with federal and state laws, company policies and procedures
    • Other duties as deemed necessary

Essential Skills and Experience:
    • 2-years workers' compensation claims experience and/or training preferred
    • High school diploma or equivalent
    • Microsoft Excel
    • Microsoft Word
    • Moderate computer proficiency
    • Mathematical skills: ability to calculate rates using addition, subtraction, multiplication and division
    • Ability to read and interpret an extensive variety of documents such as contracts, claims, instructions, policies and procedures in written (in English) and diagram form
    • Ability to write routine correspondence (in English)
    • Ability to define problems, collect data, establish facts and draw valid conclusions
    • Strong customer service orientation
    • Excellent interpersonal and communication skills
    • Strong team player
    • Commitment to company values

Nonessential Skills and Experience:
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