Medical Only Claims Spec I/II

<strong>AF Group (Lansing, Mich.) and its subsidiaries are a premier provider of innovative insurance solutions. Insurance policies may be issued by any of the following companies within AF Group: Accident Fund Insurance Company of America, Accident Fund National Insurance Company, Accident Fund General Insurance Company, United Wisconsin Insurance Company, Third Coast Insurance Company, or CompWest Insurance Company.</strong>

Lansing, USA

AF Group

<p class="p1"><strong>AF Group&rsquo;s focused and passionate team uses industry-leading best practices, analytics and resources to manage risk and minimize loss for our policyholders while strengthening businesses with our valued independent agent partners.</strong></p> <p class="p1"><strong>We strive to continuously increase the long-term value of our organization by outperforming our industry peers and fostering a culture of underwriting and claims excellence.</strong></p> https://www.afgroup.com/

keywords: summary,job description,work environment,legal,medical,teamwork,claims,assist,workers' compensation,reporting,quality assurance,coordinate,evaluate,knowledge,education,experience,skills,communication

Non-Manager

Competitive Compensation and Benefits Package

Overview: <p><span style="font-style: inherit; font-weight: inherit;">The Medical Only Claims Specialist I is an entry-level claims role. The incumbent is expected to be proficient with the Claims unit, policies, processes, procedures, and terminology.&nbsp;&nbsp;</span></p> <p><span style="font-style: inherit; font-weight: inherit;">The Medical Only Claims Specialist II is an experienced-level claims role. The incumbent is expected to perform at a high level with minimum supervision.&nbsp;</span></p> <p><span style="font-style: inherit; font-weight: inherit;">Primarily responsible for the investigation and management of workers&rsquo; compensation claims. Conducts a 1 to 3-point contact on the managed claims, which is dependent on either the facts of the case or the claim type;</span><span style="font-style: inherit; font-weight: inherit;">&nbsp;</span><span style="font-style: inherit; font-weight: inherit;">determines compensability of claims, manages the medical treatment program, and assists in the return-to-work process. This includes calling and discussing potential claim activity and work-related injuries with policyholders, claimants, providers, attorneys, agents, and state agencies. Trains and mentors other team members. Provides backup support to other Claim Handlers.&nbsp;<br /><br /><br /></span></p> <p><span style="font-style: inherit; font-weight: inherit;"><strong><strong style="font-style: inherit;">WORKING CONDITIONS:</strong></strong>&nbsp;</span></p> <p><span style="font-style: inherit; font-weight: inherit;">Work is performed in an office setting with no unusual hazards.&nbsp;</span></p> <p><span style="font-style: inherit; font-weight: inherit;">May be required to obtain reciprocal licenses in any jurisdiction requiring a license and managed by the AFICA Medical Only Claims Team (may be required to travel, submit to a background check, or provide personal information in order to obtain these licenses).</span></p> <p><span style="font-style: inherit; font-weight: inherit;">&nbsp;</span></p> <p><span style="font-style: inherit; font-weight: inherit;"><strong><strong style="font-style: inherit;">MEDICAL ONLY CLAIMS SPECIALIST I NOTES:&nbsp;</strong></strong>&nbsp;</span></p> <p><span style="font-style: inherit; font-weight: inherit;">&nbsp;</span></p> <p><span style="font-style: inherit; font-weight: inherit;"><strong><strong style="font-style: inherit;">Internal Candidate:</strong></strong>&nbsp;An incumbent who does not successfully obtain a MI or TX licenses at the end of the 180 days will not be placed in a MOCS role. If the Company is unable to return the incumbent to a bargaining-unit job the incumbent will then be placed on the recall list in accordance with Article 8.8 of the Collective Bargaining Agreement.&nbsp;</span></p> <p><span style="font-style: inherit; font-weight: inherit;"><strong><strong style="font-style: inherit;">External Candidate:&nbsp;</strong></strong>Initial probationary period 180 days. Successful completion of probationary period requires adjuster license obtained in either MI or TX.&nbsp;</span></p> <p><span style="font-style: inherit; font-weight: inherit;"><br /><br /></span></p> <p><span style="font-style: inherit; font-weight: inherit;"><strong><strong style="font-style: inherit;"><u>ADDITIONAL RESPONSIBILITIES FOR A MEDICAL ONLY CLAIMS SPECIALIST II:</u></strong></strong>&nbsp;</span></p> <ul style="font-style: inherit; font-weight: inherit;"> <li style="font-style: inherit; font-weight: inherit;" data-leveltext="" data-font="Symbol" data-listid="26" data-list-defn-props="{&quot;335552541&quot;:1,&quot;335559685&quot;:360,&quot;335559991&quot;:360,&quot;469769226&quot;:&quot;Symbol&quot;,&quot;469769242&quot;:[8226],&quot;469777803&quot;:&quot;left&quot;,&quot;469777804&quot;:&quot;&quot;,&quot;469777815&quot;:&quot;hybridMultilevel&quot;}" data-aria-posinset="1" data-aria-level="1"><span style="font-style: inherit; font-weight: inherit;">Trains and mentors other team members.&nbsp;</span></li> <li style="font-style: inherit; font-weight: inherit;" data-leveltext="" data-font="Symbol" data-listid="26" data-list-defn-props="{&quot;335552541&quot;:1,&quot;335559685&quot;:360,&quot;335559991&quot;:360,&quot;469769226&quot;:&quot;Symbol&quot;,&quot;469769242&quot;:[8226],&quot;469777803&quot;:&quot;left&quot;,&quot;469777804&quot;:&quot;&quot;,&quot;469777815&quot;:&quot;hybridMultilevel&quot;}" data-aria-posinset="1" data-aria-level="1"><span style="font-style: inherit; font-weight: inherit;">Mentors fellow team members and assists in their development as a MOCS&nbsp;</span></li> <li style="font-style: inherit; font-weight: inherit;" data-leveltext="" data-font="Symbol" data-listid="26" data-list-defn-props="{&quot;335552541&quot;:1,&quot;335559685&quot;:360,&quot;335559991&quot;:360,&quot;469769226&quot;:&quot;Symbol&quot;,&quot;469769242&quot;:[8226],&quot;469777803&quot;:&quot;left&quot;,&quot;469777804&quot;:&quot;&quot;,&quot;469777815&quot;:&quot;hybridMultilevel&quot;}" data-aria-posinset="1" data-aria-level="1"><span style="font-style: inherit; font-weight: inherit;">Works with minimum supervision.&nbsp;</span></li> <li style="font-style: inherit; font-weight: inherit;" data-leveltext="" data-font="Symbol" data-listid="26" data-list-defn-props="{&quot;335552541&quot;:1,&quot;335559685&quot;:360,&quot;335559991&quot;:360,&quot;469769226&quot;:&quot;Symbol&quot;,&quot;469769242&quot;:[8226],&quot;469777803&quot;:&quot;left&quot;,&quot;469777804&quot;:&quot;&quot;,&quot;469777815&quot;:&quot;hybridMultilevel&quot;}" data-aria-posinset="1" data-aria-level="1"><span style="font-style: inherit; font-weight: inherit;">May attend agent and/or policyholder visits.&nbsp;</span></li> </ul> <p><span style="font-style: inherit; font-weight: inherit;">&nbsp;</span></p> <p><span style="font-style: inherit; font-weight: inherit;"><strong><strong style="font-style: inherit;"><u>ADDITIONAL PRIMARY RESPONSIBILITIES FOR MAINTENANCE:</u></strong></strong>&nbsp;</span></p> <ul> <li style="font-style: inherit; font-weight: inherit;" data-leveltext="*" data-font="" data-listid="24" data-list-defn-props="{&quot;335551671&quot;:0,&quot;335552541&quot;:0,&quot;469769242&quot;:[65533,0],&quot;469777803&quot;:&quot;left&quot;,&quot;469777804&quot;:&quot;*&quot;,&quot;469777815&quot;:&quot;singleLevel&quot;}" data-aria-posinset="1" data-aria-level="1"><span style="font-style: inherit; font-weight: inherit;">Initiates indemnity payments and monitors for items such as age reduction, coordination of benefits, Stozicki, Second Injury Fund, dependent drops and supplemental payments.&nbsp;</span></li> <li style="font-style: inherit; font-weight: inherit;" data-leveltext="*" data-font="" data-listid="24" data-list-defn-props="{&quot;335551671&quot;:0,&quot;335552541&quot;:0,&quot;469769242&quot;:[65533,0],&quot;469777803&quot;:&quot;left&quot;,&quot;469777804&quot;:&quot;*&quot;,&quot;469777815&quot;:&quot;singleLevel&quot;}" data-aria-posinset="1" data-aria-level="1"><span style="font-style: inherit; font-weight: inherit;">Monitors rate of life expectancy and update/monitor reserves accordingly.&nbsp;</span></li> <li style="font-style: inherit; font-weight: inherit;" data-leveltext="*" data-font="" data-listid="24" data-list-defn-props="{&quot;335551671&quot;:0,&quot;335552541&quot;:0,&quot;469769242&quot;:[65533,0],&quot;469777803&quot;:&quot;left&quot;,&quot;469777804&quot;:&quot;*&quot;,&quot;469777815&quot;:&quot;singleLevel&quot;}" data-aria-posinset="1" data-aria-level="1"><span style="font-style: inherit; font-weight: inherit;">Compiles annual CAT assessments and reviewing with appropriate parties.&nbsp;</span></li> <li style="font-style: inherit; font-weight: inherit;" data-leveltext="*" data-font="" data-listid="24" data-list-defn-props="{&quot;335551671&quot;:0,&quot;335552541&quot;:0,&quot;469769242&quot;:[65533,0],&quot;469777803&quot;:&quot;left&quot;,&quot;469777804&quot;:&quot;*&quot;,&quot;469777815&quot;:&quot;singleLevel&quot;}" data-aria-posinset="1" data-aria-level="1"><span style="font-style: inherit; font-weight: inherit;">Evaluates cases for Stokes and PRIUM.&nbsp;</span></li> <li style="font-style: inherit; font-weight: inherit;" data-leveltext="*" data-font="" data-listid="24" data-list-defn-props="{&quot;335551671&quot;:0,&quot;335552541&quot;:0,&quot;469769242&quot;:[65533,0],&quot;469777803&quot;:&quot;left&quot;,&quot;469777804&quot;:&quot;*&quot;,&quot;469777815&quot;:&quot;singleLevel&quot;}" data-aria-posinset="1" data-aria-level="1"><span style="font-style: inherit; font-weight: inherit;">Coordinates with outside vendors to ensure cost containment efforts&nbsp;</span></li> <li style="font-style: inherit; font-weight: inherit;" data-leveltext="*" data-font="" data-listid="24" data-list-defn-props="{&quot;335551671&quot;:0,&quot;335552541&quot;:0,&quot;469769242&quot;:[65533,0],&quot;469777803&quot;:&quot;left&quot;,&quot;469777804&quot;:&quot;*&quot;,&quot;469777815&quot;:&quot;singleLevel&quot;}" data-aria-posinset="1" data-aria-level="1"><span style="font-style: inherit; font-weight: inherit;">Works closely with manager on complex files or files above reserve authority.&nbsp;&nbsp;&nbsp;</span></li> </ul> <br /> <p><span style="font-style: inherit; font-weight: inherit;"><br /></span><strong><strong style="font-style: inherit;">ADDITIONAL EDUCATION, EXPERIENCE, SKILLS, KNOWLEDGE AND/OR ABILITIES PREFERRED:</strong></strong><em><em style="font-weight: inherit;">&nbsp;</em></em></p> <ul> <li style="font-style: inherit; font-weight: inherit;" data-leveltext="*" data-font="" data-listid="1" data-list-defn-props="{&quot;335551671&quot;:0,&quot;335552541&quot;:0,&quot;469769242&quot;:[65533,0],&quot;469777803&quot;:&quot;left&quot;,&quot;469777804&quot;:&quot;*&quot;,&quot;469777815&quot;:&quot;singleLevel&quot;}" data-aria-posinset="17" data-aria-level="1"><span style="font-style: inherit; font-weight: inherit;">Progress towards or completion of Insurance Institute of America (IIA) or other insurance related designation(s) preferred.&nbsp;</span></li> </ul> <br /> <p><span style="font-style: inherit; font-weight: inherit;">&nbsp;</span></p> <p><span style="font-style: inherit; font-weight: inherit;">&nbsp;</span></p>
Responsibilities: <p>&nbsp;</p> <ul style="font-style: inherit; font-weight: inherit;"> <li style="font-style: inherit; font-weight: inherit;" data-leveltext="" data-font="Symbol" data-listid="9" data-list-defn-props="{&quot;335552541&quot;:1,&quot;335559685&quot;:720,&quot;335559991&quot;:360,&quot;469769226&quot;:&quot;Symbol&quot;,&quot;469769242&quot;:[8226],&quot;469777803&quot;:&quot;left&quot;,&quot;469777804&quot;:&quot;&quot;,&quot;469777815&quot;:&quot;singleLevel&quot;}" data-aria-posinset="1" data-aria-level="1"><span style="font-style: inherit; font-weight: inherit;">Investigates workers&rsquo; compensation claims with a mandatory contact to the employer within the required time frame with additional contacts to the employee or provider, as necessary.&nbsp; &nbsp;&nbsp;</span></li> <li style="font-style: inherit; font-weight: inherit;" data-leveltext="" data-font="Symbol" data-listid="9" data-list-defn-props="{&quot;335552541&quot;:1,&quot;335559685&quot;:720,&quot;335559991&quot;:360,&quot;469769226&quot;:&quot;Symbol&quot;,&quot;469769242&quot;:[8226],&quot;469777803&quot;:&quot;left&quot;,&quot;469777804&quot;:&quot;&quot;,&quot;469777815&quot;:&quot;singleLevel&quot;}" data-aria-posinset="1" data-aria-level="1"><span style="font-style: inherit; font-weight: inherit;">Documents claim file.&nbsp;</span></li> <li style="font-style: inherit; font-weight: inherit;" data-leveltext="" data-font="Symbol" data-listid="9" data-list-defn-props="{&quot;335552541&quot;:1,&quot;335559685&quot;:720,&quot;335559991&quot;:360,&quot;469769226&quot;:&quot;Symbol&quot;,&quot;469769242&quot;:[8226],&quot;469777803&quot;:&quot;left&quot;,&quot;469777804&quot;:&quot;&quot;,&quot;469777815&quot;:&quot;singleLevel&quot;}" data-aria-posinset="1" data-aria-level="1"><span style="font-style: inherit; font-weight: inherit;">Verifies workers&rsquo; compensation coverage (statutory and policy) of employers and injured employees.&nbsp;&nbsp;&nbsp;</span></li> <li style="font-style: inherit; font-weight: inherit;" data-leveltext="" data-font="Symbol" data-listid="9" data-list-defn-props="{&quot;335552541&quot;:1,&quot;335559685&quot;:720,&quot;335559991&quot;:360,&quot;469769226&quot;:&quot;Symbol&quot;,&quot;469769242&quot;:[8226],&quot;469777803&quot;:&quot;left&quot;,&quot;469777804&quot;:&quot;&quot;,&quot;469777815&quot;:&quot;singleLevel&quot;}" data-aria-posinset="1" data-aria-level="1"><span style="font-style: inherit; font-weight: inherit;">Determines, documents, and manages the on-going medical treatment program including directing care, creating jurisdictional specific panels, and approving provider requests.&nbsp;&nbsp;</span></li> <li style="font-style: inherit; font-weight: inherit;" data-leveltext="" data-font="Symbol" data-listid="9" data-list-defn-props="{&quot;335552541&quot;:1,&quot;335559685&quot;:720,&quot;335559991&quot;:360,&quot;469769226&quot;:&quot;Symbol&quot;,&quot;469769242&quot;:[8226],&quot;469777803&quot;:&quot;left&quot;,&quot;469777804&quot;:&quot;&quot;,&quot;469777815&quot;:&quot;singleLevel&quot;}" data-aria-posinset="1" data-aria-level="1"><span style="font-style: inherit; font-weight: inherit;">Remains abreast of new case law decisions affecting claim and medical management.&nbsp;</span></li> <li style="font-style: inherit; font-weight: inherit;" data-leveltext="" data-font="Symbol" data-listid="9" data-list-defn-props="{&quot;335552541&quot;:1,&quot;335559685&quot;:720,&quot;335559991&quot;:360,&quot;469769226&quot;:&quot;Symbol&quot;,&quot;469769242&quot;:[8226],&quot;469777803&quot;:&quot;left&quot;,&quot;469777804&quot;:&quot;&quot;,&quot;469777815&quot;:&quot;singleLevel&quot;}" data-aria-posinset="1" data-aria-level="1"><span style="font-style: inherit; font-weight: inherit;">Monitors the work status of the injured workers.&nbsp;</span></li> <li style="font-style: inherit; font-weight: inherit;" data-leveltext="" data-font="Symbol" data-listid="9" data-list-defn-props="{&quot;335552541&quot;:1,&quot;335559685&quot;:720,&quot;335559991&quot;:360,&quot;469769226&quot;:&quot;Symbol&quot;,&quot;469769242&quot;:[8226],&quot;469777803&quot;:&quot;left&quot;,&quot;469777804&quot;:&quot;&quot;,&quot;469777815&quot;:&quot;singleLevel&quot;}" data-aria-posinset="1" data-aria-level="1"><span style="font-style: inherit; font-weight: inherit;">Evaluates medical reports and correspondence for appropriate action/documentation&nbsp;</span></li> <li style="font-style: inherit; font-weight: inherit;" data-leveltext="" data-font="Symbol" data-listid="9" data-list-defn-props="{&quot;335552541&quot;:1,&quot;335559685&quot;:720,&quot;335559991&quot;:360,&quot;469769226&quot;:&quot;Symbol&quot;,&quot;469769242&quot;:[8226],&quot;469777803&quot;:&quot;left&quot;,&quot;469777804&quot;:&quot;&quot;,&quot;469777815&quot;:&quot;singleLevel&quot;}" data-aria-posinset="1" data-aria-level="1"><span style="font-style: inherit; font-weight: inherit;">Supports the customer service work and processes for the multi-functional claims team; Communicates and collaborates with team members to ensure the appropriate and timely handling of claims in other states.&nbsp;</span></li> <li style="font-style: inherit; font-weight: inherit;" data-leveltext="" data-font="Symbol" data-listid="9" data-list-defn-props="{&quot;335552541&quot;:1,&quot;335559685&quot;:720,&quot;335559991&quot;:360,&quot;469769226&quot;:&quot;Symbol&quot;,&quot;469769242&quot;:[8226],&quot;469777803&quot;:&quot;left&quot;,&quot;469777804&quot;:&quot;&quot;,&quot;469777815&quot;:&quot;singleLevel&quot;}" data-aria-posinset="1" data-aria-level="1"><span style="font-style: inherit; font-weight: inherit;">May be required to handle multiple jurisdictions based on team needs.&nbsp;</span></li> <li style="font-style: inherit; font-weight: inherit;" data-leveltext="" data-font="Symbol" data-listid="9" data-list-defn-props="{&quot;335552541&quot;:1,&quot;335559685&quot;:720,&quot;335559991&quot;:360,&quot;469769226&quot;:&quot;Symbol&quot;,&quot;469769242&quot;:[8226],&quot;469777803&quot;:&quot;left&quot;,&quot;469777804&quot;:&quot;&quot;,&quot;469777815&quot;:&quot;singleLevel&quot;}" data-aria-posinset="1" data-aria-level="1"><span style="font-style: inherit; font-weight: inherit;">Establishes timely and appropriate reserves based on the profile of the claim within given authority based on anticipated financial exposure. Documents in the claim file the basis for reserve calculations.&nbsp;&nbsp;</span></li> <li style="font-style: inherit; font-weight: inherit;" data-leveltext="" data-font="Symbol" data-listid="9" data-list-defn-props="{&quot;335552541&quot;:1,&quot;335559685&quot;:720,&quot;335559991&quot;:360,&quot;469769226&quot;:&quot;Symbol&quot;,&quot;469769242&quot;:[8226],&quot;469777803&quot;:&quot;left&quot;,&quot;469777804&quot;:&quot;&quot;,&quot;469777815&quot;:&quot;singleLevel&quot;}" data-aria-posinset="1" data-aria-level="1"><span style="font-style: inherit; font-weight: inherit;">Determines causal relationship between the reported injury and the incident to ensure appropriate payment of benefits.&nbsp;</span></li> <li style="font-style: inherit; font-weight: inherit;" data-leveltext="" data-font="Symbol" data-listid="9" data-list-defn-props="{&quot;335552541&quot;:1,&quot;335559685&quot;:720,&quot;335559991&quot;:360,&quot;469769226&quot;:&quot;Symbol&quot;,&quot;469769242&quot;:[8226],&quot;469777803&quot;:&quot;left&quot;,&quot;469777804&quot;:&quot;&quot;,&quot;469777815&quot;:&quot;singleLevel&quot;}" data-aria-posinset="1" data-aria-level="1"><span style="font-style: inherit; font-weight: inherit;">Documents specifics of claims with potential for subrogation recovery&nbsp;&nbsp;</span></li> <li style="font-style: inherit; font-weight: inherit;" data-leveltext="" data-font="Symbol" data-listid="9" data-list-defn-props="{&quot;335552541&quot;:1,&quot;335559685&quot;:720,&quot;335559991&quot;:360,&quot;469769226&quot;:&quot;Symbol&quot;,&quot;469769242&quot;:[8226],&quot;469777803&quot;:&quot;left&quot;,&quot;469777804&quot;:&quot;&quot;,&quot;469777815&quot;:&quot;singleLevel&quot;}" data-aria-posinset="1" data-aria-level="1"><span style="font-style: inherit; font-weight: inherit;">Assists Subro representative with investigation.&nbsp;&nbsp;</span></li> <li style="font-style: inherit; font-weight: inherit;" data-leveltext="" data-font="Symbol" data-listid="9" data-list-defn-props="{&quot;335552541&quot;:1,&quot;335559685&quot;:720,&quot;335559991&quot;:360,&quot;469769226&quot;:&quot;Symbol&quot;,&quot;469769242&quot;:[8226],&quot;469777803&quot;:&quot;left&quot;,&quot;469777804&quot;:&quot;&quot;,&quot;469777815&quot;:&quot;singleLevel&quot;}" data-aria-posinset="1" data-aria-level="1"><span style="font-style: inherit; font-weight: inherit;">Engages ISU to obtain police reports.&nbsp;</span></li> <li style="font-style: inherit; font-weight: inherit;" data-leveltext="" data-font="Symbol" data-listid="9" data-list-defn-props="{&quot;335552541&quot;:1,&quot;335559685&quot;:720,&quot;335559991&quot;:360,&quot;469769226&quot;:&quot;Symbol&quot;,&quot;469769242&quot;:[8226],&quot;469777803&quot;:&quot;left&quot;,&quot;469777804&quot;:&quot;&quot;,&quot;469777815&quot;:&quot;singleLevel&quot;}" data-aria-posinset="1" data-aria-level="1"><span style="font-style: inherit; font-weight: inherit;">Approves, edits, and denies payment based on knowledge of the treatment plan and medical support showing relationship of treatment to the injury.&nbsp;</span></li> <li style="font-style: inherit; font-weight: inherit;" data-leveltext="" data-font="Symbol" data-listid="9" data-list-defn-props="{&quot;335552541&quot;:1,&quot;335559685&quot;:720,&quot;335559991&quot;:360,&quot;469769226&quot;:&quot;Symbol&quot;,&quot;469769242&quot;:[8226],&quot;469777803&quot;:&quot;left&quot;,&quot;469777804&quot;:&quot;&quot;,&quot;469777815&quot;:&quot;singleLevel&quot;}" data-aria-posinset="1" data-aria-level="1"><span style="font-style: inherit; font-weight: inherit;">Concludes and closes files following resolution of claims to meet internal performance standards while complying with state legislation to avoid penalties and manage expenses.&nbsp;</span></li> <li style="font-style: inherit; font-weight: inherit;" data-leveltext="" data-font="Symbol" data-listid="9" data-list-defn-props="{&quot;335552541&quot;:1,&quot;335559685&quot;:720,&quot;335559991&quot;:360,&quot;469769226&quot;:&quot;Symbol&quot;,&quot;469769242&quot;:[8226],&quot;469777803&quot;:&quot;left&quot;,&quot;469777804&quot;:&quot;&quot;,&quot;469777815&quot;:&quot;singleLevel&quot;}" data-aria-posinset="1" data-aria-level="1"><span style="font-style: inherit; font-weight: inherit;">Coordinates with outside vendors to ensure cost containment efforts.&nbsp;&nbsp;</span></li> <li style="font-style: inherit; font-weight: inherit;" data-leveltext="" data-font="Symbol" data-listid="9" data-list-defn-props="{&quot;335552541&quot;:1,&quot;335559685&quot;:720,&quot;335559991&quot;:360,&quot;469769226&quot;:&quot;Symbol&quot;,&quot;469769242&quot;:[8226],&quot;469777803&quot;:&quot;left&quot;,&quot;469777804&quot;:&quot;&quot;,&quot;469777815&quot;:&quot;singleLevel&quot;}" data-aria-posinset="1" data-aria-level="1"><span style="font-style: inherit; font-weight: inherit;">Establishes and maintains effective working relationships with all internal and external customers. Assists with determining appropriate response to regulatory inquiries.&nbsp;</span></li> <li style="font-style: inherit; font-weight: inherit;" data-leveltext="" data-font="Symbol" data-listid="9" data-list-defn-props="{&quot;335552541&quot;:1,&quot;335559685&quot;:720,&quot;335559991&quot;:360,&quot;469769226&quot;:&quot;Symbol&quot;,&quot;469769242&quot;:[8226],&quot;469777803&quot;:&quot;left&quot;,&quot;469777804&quot;:&quot;&quot;,&quot;469777815&quot;:&quot;singleLevel&quot;}" data-aria-posinset="1" data-aria-level="1"><span style="font-style: inherit; font-weight: inherit;">Coordinates all efforts with proprietary technology, including causation investigations, Care Analytics, and future models.&nbsp;&nbsp;&nbsp;</span></li> <li style="font-style: inherit; font-weight: inherit;" data-leveltext="" data-font="Symbol" data-listid="9" data-list-defn-props="{&quot;335552541&quot;:1,&quot;335559685&quot;:720,&quot;335559991&quot;:360,&quot;469769226&quot;:&quot;Symbol&quot;,&quot;469769242&quot;:[8226],&quot;469777803&quot;:&quot;left&quot;,&quot;469777804&quot;:&quot;&quot;,&quot;469777815&quot;:&quot;singleLevel&quot;}" data-aria-posinset="1" data-aria-level="1"><span style="font-style: inherit; font-weight: inherit;">Determines appropriate response to regulatory inquiries and completes statutory filings, including EDI data completion&nbsp;</span></li> <li style="font-style: inherit; font-weight: inherit;" data-leveltext="" data-font="Symbol" data-listid="9" data-list-defn-props="{&quot;335552541&quot;:1,&quot;335559685&quot;:720,&quot;335559991&quot;:360,&quot;469769226&quot;:&quot;Symbol&quot;,&quot;469769242&quot;:[8226],&quot;469777803&quot;:&quot;left&quot;,&quot;469777804&quot;:&quot;&quot;,&quot;469777815&quot;:&quot;singleLevel&quot;}" data-aria-posinset="1" data-aria-level="1"><span style="font-style: inherit; font-weight: inherit;">Composes correspondence and various reports in the administration of workers compensation claims; sets appropriate diaries.&nbsp;&nbsp;</span></li> <li style="font-style: inherit; font-weight: inherit;" data-leveltext="" data-font="Symbol" data-listid="9" data-list-defn-props="{&quot;335552541&quot;:1,&quot;335559685&quot;:720,&quot;335559991&quot;:360,&quot;469769226&quot;:&quot;Symbol&quot;,&quot;469769242&quot;:[8226],&quot;469777803&quot;:&quot;left&quot;,&quot;469777804&quot;:&quot;&quot;,&quot;469777815&quot;:&quot;singleLevel&quot;}" data-aria-posinset="1" data-aria-level="1"><span style="font-style: inherit; font-weight: inherit;">Reads, routes and keys incoming mail, runs reports and answers/responds to incoming phone calls on both direct and ACD line, faxes, and emails. This may include completing work for peers during absences to provide uninterrupted service to customers.&nbsp;</span></li> <li style="font-style: inherit; font-weight: inherit;" data-leveltext="" data-font="Symbol" data-listid="9" data-list-defn-props="{&quot;335552541&quot;:1,&quot;335559685&quot;:720,&quot;335559991&quot;:360,&quot;469769226&quot;:&quot;Symbol&quot;,&quot;469769242&quot;:[8226],&quot;469777803&quot;:&quot;left&quot;,&quot;469777804&quot;:&quot;&quot;,&quot;469777815&quot;:&quot;singleLevel&quot;}" data-aria-posinset="1" data-aria-level="1"><span style="font-style: inherit; font-weight: inherit;">Schedules independent medical evaluations and provides synopsis and outlines all questions to IME physician. Upon receipt of results, communicates to all parties, facilitates future treatment, or may result in formal denials being filed.</span></li> <li style="font-style: inherit; font-weight: inherit;" data-leveltext="" data-font="Symbol" data-listid="9" data-list-defn-props="{&quot;335552541&quot;:1,&quot;335559685&quot;:720,&quot;335559991&quot;:360,&quot;469769226&quot;:&quot;Symbol&quot;,&quot;469769242&quot;:[8226],&quot;469777803&quot;:&quot;left&quot;,&quot;469777804&quot;:&quot;&quot;,&quot;469777815&quot;:&quot;singleLevel&quot;}" data-aria-posinset="1" data-aria-level="1"><span style="font-style: inherit; font-weight: inherit;">Assigns ISU to complete causation investigation.</span></li> <li style="font-style: inherit; font-weight: inherit;" data-leveltext="" data-font="Symbol" data-listid="9" data-list-defn-props="{&quot;335552541&quot;:1,&quot;335559685&quot;:720,&quot;335559991&quot;:360,&quot;469769226&quot;:&quot;Symbol&quot;,&quot;469769242&quot;:[8226],&quot;469777803&quot;:&quot;left&quot;,&quot;469777804&quot;:&quot;&quot;,&quot;469777815&quot;:&quot;singleLevel&quot;}" data-aria-posinset="1" data-aria-level="1"><span style="font-style: inherit; font-weight: inherit;">Stays abreast of changes in workers&rsquo; compensation statutes, case law and rehabilitation efforts/advancements to accurately interpret and apply relevant laws.&nbsp;</span></li> <li style="font-style: inherit; font-weight: inherit;" data-leveltext="" data-font="Symbol" data-listid="9" data-list-defn-props="{&quot;335552541&quot;:1,&quot;335559685&quot;:720,&quot;335559991&quot;:360,&quot;469769226&quot;:&quot;Symbol&quot;,&quot;469769242&quot;:[8226],&quot;469777803&quot;:&quot;left&quot;,&quot;469777804&quot;:&quot;&quot;,&quot;469777815&quot;:&quot;singleLevel&quot;}" data-aria-posinset="1" data-aria-level="1"><span style="font-style: inherit; font-weight: inherit;">Handles telephonic mediations to avoid litigation.&nbsp;</span></li> <li style="font-style: inherit; font-weight: inherit;" data-leveltext="" data-font="Symbol" data-listid="9" data-list-defn-props="{&quot;335552541&quot;:1,&quot;335559685&quot;:720,&quot;335559991&quot;:360,&quot;469769226&quot;:&quot;Symbol&quot;,&quot;469769242&quot;:[8226],&quot;469777803&quot;:&quot;left&quot;,&quot;469777804&quot;:&quot;&quot;,&quot;469777815&quot;:&quot;singleLevel&quot;}" data-aria-posinset="1" data-aria-level="1"><span style="font-style: inherit; font-weight: inherit;">Communicates with plaintiff&rsquo;s attorney and provides limited records to potentially avoid unnecessary litigation. Active litigation is transferred to another team. May handle mediation or teleconference dependent on the circumstances&nbsp;</span></li> <li style="font-style: inherit; font-weight: inherit;" data-leveltext="" data-font="Symbol" data-listid="9" data-list-defn-props="{&quot;335552541&quot;:1,&quot;335559685&quot;:720,&quot;335559991&quot;:360,&quot;469769226&quot;:&quot;Symbol&quot;,&quot;469769242&quot;:[8226],&quot;469777803&quot;:&quot;left&quot;,&quot;469777804&quot;:&quot;&quot;,&quot;469777815&quot;:&quot;singleLevel&quot;}" data-aria-posinset="1" data-aria-level="1"><span style="font-style: inherit; font-weight: inherit;">Manages prescription requests, medical treatment, and ongoing return to work options for injured employees&nbsp;</span></li> <li style="font-style: inherit; font-weight: inherit;" data-leveltext="" data-font="Symbol" data-listid="9" data-list-defn-props="{&quot;335552541&quot;:1,&quot;335559685&quot;:720,&quot;335559991&quot;:360,&quot;469769226&quot;:&quot;Symbol&quot;,&quot;469769242&quot;:[8226],&quot;469777803&quot;:&quot;left&quot;,&quot;469777804&quot;:&quot;&quot;,&quot;469777815&quot;:&quot;singleLevel&quot;}" data-aria-posinset="1" data-aria-level="1"><span style="font-style: inherit; font-weight: inherit;">Facilitates return to work for the injured employee and monitors work status on medical only claims with a keep at work focus.&nbsp;</span></li> <li style="font-style: inherit; font-weight: inherit;" data-leveltext="" data-font="Symbol" data-listid="9" data-list-defn-props="{&quot;335552541&quot;:1,&quot;335559685&quot;:720,&quot;335559991&quot;:360,&quot;469769226&quot;:&quot;Symbol&quot;,&quot;469769242&quot;:[8226],&quot;469777803&quot;:&quot;left&quot;,&quot;469777804&quot;:&quot;&quot;,&quot;469777815&quot;:&quot;singleLevel&quot;}" data-aria-posinset="1" data-aria-level="1"><span style="font-style: inherit; font-weight: inherit;">May serve as an adjuster to the dedicated account representative.</span></li> <li style="font-style: inherit; font-weight: inherit;" data-leveltext="" data-font="Symbol" data-listid="9" data-list-defn-props="{&quot;335552541&quot;:1,&quot;335559685&quot;:720,&quot;335559991&quot;:360,&quot;469769226&quot;:&quot;Symbol&quot;,&quot;469769242&quot;:[8226],&quot;469777803&quot;:&quot;left&quot;,&quot;469777804&quot;:&quot;&quot;,&quot;469777815&quot;:&quot;singleLevel&quot;}" data-aria-posinset="1" data-aria-level="1"><span style="font-style: inherit; font-weight: inherit;">Supports the team, as required, by acting as a backup to the MOCS, and Claims Representatives.&nbsp;</span></li> <li style="font-style: inherit; font-weight: inherit;" data-leveltext="" data-font="Symbol" data-listid="9" data-list-defn-props="{&quot;335552541&quot;:1,&quot;335559685&quot;:720,&quot;335559991&quot;:360,&quot;469769226&quot;:&quot;Symbol&quot;,&quot;469769242&quot;:[8226],&quot;469777803&quot;:&quot;left&quot;,&quot;469777804&quot;:&quot;&quot;,&quot;469777815&quot;:&quot;singleLevel&quot;}" data-aria-posinset="1" data-aria-level="1"><span style="font-style: inherit; font-weight: inherit;">Responsible to set the initial reserve and any subsequent changes on indemnity files.&nbsp;</span></li> <li style="font-style: inherit; font-weight: inherit;" data-leveltext="" data-font="Symbol" data-listid="9" data-list-defn-props="{&quot;335552541&quot;:1,&quot;335559685&quot;:720,&quot;335559991&quot;:360,&quot;469769226&quot;:&quot;Symbol&quot;,&quot;469769242&quot;:[8226],&quot;469777803&quot;:&quot;left&quot;,&quot;469777804&quot;:&quot;&quot;,&quot;469777815&quot;:&quot;singleLevel&quot;}" data-aria-posinset="1" data-aria-level="1"><span style="font-style: inherit; font-weight: inherit;">Approves, edits and denies medical bills for non-indemnity and indemnity claims directly associated with the claimed injury based on knowledge of the treatment plan and medical support showing relationship of treatment to the injury.&nbsp;</span></li> <li style="font-style: inherit; font-weight: inherit;" data-leveltext="" data-font="Symbol" data-listid="9" data-list-defn-props="{&quot;335552541&quot;:1,&quot;335559685&quot;:720,&quot;335559991&quot;:360,&quot;469769226&quot;:&quot;Symbol&quot;,&quot;469769242&quot;:[8226],&quot;469777803&quot;:&quot;left&quot;,&quot;469777804&quot;:&quot;&quot;,&quot;469777815&quot;:&quot;singleLevel&quot;}" data-aria-posinset="1" data-aria-level="1"><span style="font-style: inherit; font-weight: inherit;">Conducts employee-employer interviews to assist in the return-to-work process.&nbsp;&nbsp;</span></li> <li style="font-style: inherit; font-weight: inherit;" data-leveltext="" data-font="Symbol" data-listid="9" data-list-defn-props="{&quot;335552541&quot;:1,&quot;335559685&quot;:720,&quot;335559991&quot;:360,&quot;469769226&quot;:&quot;Symbol&quot;,&quot;469769242&quot;:[8226],&quot;469777803&quot;:&quot;left&quot;,&quot;469777804&quot;:&quot;&quot;,&quot;469777815&quot;:&quot;singleLevel&quot;}" data-aria-posinset="1" data-aria-level="1"><span style="font-style: inherit; font-weight: inherit;">Supports the account management process appropriately for the team&rsquo;s block of business.&nbsp;</span></li> </ul> <p><span style="font-style: inherit; font-weight: inherit;">&nbsp;</span></p> <p><span style="font-style: inherit; font-weight: inherit;">&nbsp;</span></p> <p><span style="font-style: inherit; font-weight: inherit;"><em><em style="font-weight: inherit;">This description identifies the responsibilities typically associated with the performance of the job. The percentage of time in any responsibility may vary between positions. Other relevant essential functions may be required.</em></em>&nbsp;</span></p>
Requirements: <span style="font-style: inherit; font-weight: inherit;"><strong><strong style="font-style: inherit;">EDUCATION REQUIRED:&nbsp;<br /><br /></strong></strong></span> <p><span style="font-style: inherit; font-weight: inherit;"><strong><strong style="font-style: inherit;">MEDICAL ONLY CLAIMS SPECIALIST I:</strong></strong>&nbsp;</span></p> <p><span style="font-style: inherit; font-weight: inherit;">&nbsp;</span></p> <ul> <li><span style="font-style: inherit; font-weight: inherit;">High school diploma.</span></li> <li><span style="font-style: inherit; font-weight: inherit;">MI or TX license is required with 180 days of start date.</span></li> </ul> <p><span style="font-style: inherit; font-weight: inherit;">&nbsp;</span></p> <p><span style="font-style: inherit; font-weight: inherit;"><strong><strong style="font-style: inherit;">MEDICAL ONLY CLAIMS SPECIALIST II:</strong></strong>&nbsp;<br /><br /></span></p> <ul> <li><span style="font-style: inherit; font-weight: inherit;">Associate degree in insurance and/or related field with progress towards or completion of Insurance Institute of America (IIA) or other insurance related designation(s). Combinations of education and experience may be considered in lieu of a degree.&nbsp;</span><span style="font-style: inherit; font-weight: inherit;">&nbsp;</span></li> <li><span style="font-style: inherit; font-weight: inherit;">MI or TX license required.&nbsp;</span></li> </ul> <p><span style="font-style: inherit; font-weight: inherit;">&nbsp;<br /><br /></span><strong><strong style="font-style: inherit;">EXPERIENCE REQUIRED:&nbsp;<br /><br /></strong></strong></p> <p><span style="font-style: inherit; font-weight: inherit;"><strong><strong style="font-style: inherit;">MEDICAL ONLY CLAIMS SPECIALIST I:</strong></strong>&nbsp;<br /><br /></span></p> <ul> <li><span style="font-style: inherit; font-weight: inherit;">Successful completion of Medical Only Claims Specialist training program.&nbsp;&nbsp;</span></li> </ul> <p><span style="font-style: inherit; font-weight: inherit;">OR&nbsp;</span></p> <ul> <li><span style="font-style: inherit; font-weight: inherit;">30 credit hours towards an Associate degree in insurance, business administration, health administration and/or a related field. Minimum of Two (2) years' insurance experience, including one (1) year of demonstrated technical knowledge (i.e., applying relevant workers compensation laws, regulations, guidelines, and/or policies that would impact claims and/or underwriting outcomes). Relevant customer service experience exchanging information and answering and resolving inquiries over the phone. Combination of education and experience may be considered in lieu of credit hours.&nbsp;</span></li> </ul> <p><span style="font-style: inherit; font-weight: inherit;">OR&nbsp;</span></p> <ul> <li><span style="font-style: inherit; font-weight: inherit;">Associate degree in insurance, business administration, health administration and/or related field with progress towards or completion of Insurance Institute of America (IIA) or other insurance related designation(s) and two (2) years of insurance experience including one (1) year experience in a property &amp; casualty claims role (i.e., applying regulations, guidelines, and/or policies that would impact claims and/or underwriting outcomes in a property &amp; casualty environment). Combination of education and experience may be considered in lieu of a degree.&nbsp;</span></li> </ul> <p><span style="font-style: inherit; font-weight: inherit;">&nbsp;</span></p> <p><span style="font-style: inherit; font-weight: inherit;"><strong><strong style="font-style: inherit;">MEDICAL ONLY CLAIMS SPECIALIST II (MOCS II):</strong></strong>&nbsp;</span></p> <p><span style="font-style: inherit; font-weight: inherit;">&nbsp;</span></p> <ul> <li><span style="font-style: inherit; font-weight: inherit;">1 year of experience as a MOCS I with demonstrated competency in multiple jurisdictions.&nbsp;&nbsp;</span></li> </ul> <p><span style="font-style: inherit; font-weight: inherit;">OR&nbsp;</span></p> <ul> <li><span style="font-style: inherit; font-weight: inherit;">Minimum of three (3) years' insurance experience. Two (2) years of demonstrated technical knowledge (i.e., applying relevant workers compensation laws, regulations, guidelines, and/or policies that would impact claims and/or underwriting outcomes) including one (1) year of managing workers' compensation claims required. Relevant customer service experience exchanging information and answering and resolving inquiries over the phone required.&nbsp;</span></li> </ul> <p><span style="font-style: inherit; font-weight: inherit;">&nbsp;<br /><br /></span><strong><strong style="font-style: inherit;">SKILLS/KNOWLEDGE/ABILITIES (SKA) REQUIRED:&nbsp;</strong></strong></p> <p><span style="font-style: inherit; font-weight: inherit;">&nbsp;</span></p> <ul> <li style="font-style: inherit; font-weight: inherit;" data-leveltext="*" data-font="" data-listid="24" data-list-defn-props="{&quot;335551671&quot;:0,&quot;335552541&quot;:0,&quot;469769242&quot;:[65533,0],&quot;469777803&quot;:&quot;left&quot;,&quot;469777804&quot;:&quot;*&quot;,&quot;469777815&quot;:&quot;singleLevel&quot;}" data-aria-posinset="7" data-aria-level="1"><span style="font-style: inherit; font-weight: inherit;">General knowledge of claims operations specifically claims processes.&nbsp;</span></li> <li style="font-style: inherit; font-weight: inherit;" data-leveltext="*" data-font="" data-listid="24" data-list-defn-props="{&quot;335551671&quot;:0,&quot;335552541&quot;:0,&quot;469769242&quot;:[65533,0],&quot;469777803&quot;:&quot;left&quot;,&quot;469777804&quot;:&quot;*&quot;,&quot;469777815&quot;:&quot;singleLevel&quot;}" data-aria-posinset="7" data-aria-level="1"><span style="font-style: inherit; font-weight: inherit;">Ability to work effectively in a multifunctional business unit.&nbsp;</span></li> <li style="font-style: inherit; font-weight: inherit;" data-leveltext="*" data-font="" data-listid="24" data-list-defn-props="{&quot;335551671&quot;:0,&quot;335552541&quot;:0,&quot;469769242&quot;:[65533,0],&quot;469777803&quot;:&quot;left&quot;,&quot;469777804&quot;:&quot;*&quot;,&quot;469777815&quot;:&quot;singleLevel&quot;}" data-aria-posinset="7" data-aria-level="1"><span style="font-style: inherit; font-weight: inherit;">Excellent verbal and written communication skills.&nbsp;</span></li> <li style="font-style: inherit; font-weight: inherit;" data-leveltext="*" data-font="" data-listid="24" data-list-defn-props="{&quot;335551671&quot;:0,&quot;335552541&quot;:0,&quot;469769242&quot;:[65533,0],&quot;469777803&quot;:&quot;left&quot;,&quot;469777804&quot;:&quot;*&quot;,&quot;469777815&quot;:&quot;singleLevel&quot;}" data-aria-posinset="7" data-aria-level="1"><span style="font-style: inherit; font-weight: inherit;">Ability to use diplomacy, discretion, and appropriate judgment when responding to inquiries from staff and external customers as well as anticipating needs of the department.&nbsp;</span></li> <li style="font-style: inherit; font-weight: inherit;" data-leveltext="*" data-font="" data-listid="24" data-list-defn-props="{&quot;335551671&quot;:0,&quot;335552541&quot;:0,&quot;469769242&quot;:[65533,0],&quot;469777803&quot;:&quot;left&quot;,&quot;469777804&quot;:&quot;*&quot;,&quot;469777815&quot;:&quot;singleLevel&quot;}" data-aria-posinset="7" data-aria-level="1"><span style="font-style: inherit; font-weight: inherit;">Ability to effectively exchange information clearly and concisely, and present ideas, report facts and other information and respond to questions as appropriate.&nbsp;</span></li> <li style="font-style: inherit; font-weight: inherit;" data-leveltext="*" data-font="" data-listid="24" data-list-defn-props="{&quot;335551671&quot;:0,&quot;335552541&quot;:0,&quot;469769242&quot;:[65533,0],&quot;469777803&quot;:&quot;left&quot;,&quot;469777804&quot;:&quot;*&quot;,&quot;469777815&quot;:&quot;singleLevel&quot;}" data-aria-posinset="7" data-aria-level="1"><span style="font-style: inherit; font-weight: inherit;">Basic knowledge of Workers' Compensation in one or more states including jurisdictional laws.&nbsp;&nbsp;</span></li> <li style="font-style: inherit; font-weight: inherit;" data-leveltext="*" data-font="" data-listid="24" data-list-defn-props="{&quot;335551671&quot;:0,&quot;335552541&quot;:0,&quot;469769242&quot;:[65533,0],&quot;469777803&quot;:&quot;left&quot;,&quot;469777804&quot;:&quot;*&quot;,&quot;469777815&quot;:&quot;singleLevel&quot;}" data-aria-posinset="7" data-aria-level="1"><span style="font-style: inherit; font-weight: inherit;">Basic knowledge of statutory standards in multiple states.&nbsp;</span></li> <li style="font-style: inherit; font-weight: inherit;" data-leveltext="*" data-font="" data-listid="24" data-list-defn-props="{&quot;335551671&quot;:0,&quot;335552541&quot;:0,&quot;469769242&quot;:[65533,0],&quot;469777803&quot;:&quot;left&quot;,&quot;469777804&quot;:&quot;*&quot;,&quot;469777815&quot;:&quot;singleLevel&quot;}" data-aria-posinset="7" data-aria-level="1"><span style="font-style: inherit; font-weight: inherit;">Ability to apply relevant workers&rsquo; compensation laws and regulations, including jurisdictional laws.&nbsp;</span></li> <li style="font-style: inherit; font-weight: inherit;" data-leveltext="*" data-font="" data-listid="24" data-list-defn-props="{&quot;335551671&quot;:0,&quot;335552541&quot;:0,&quot;469769242&quot;:[65533,0],&quot;469777803&quot;:&quot;left&quot;,&quot;469777804&quot;:&quot;*&quot;,&quot;469777815&quot;:&quot;singleLevel&quot;}" data-aria-posinset="7" data-aria-level="1"><span style="font-style: inherit; font-weight: inherit;">Ability to negotiate, build consensus, and resolve conflict.&nbsp;</span></li> <li style="font-style: inherit; font-weight: inherit;" data-leveltext="*" data-font="" data-listid="24" data-list-defn-props="{&quot;335551671&quot;:0,&quot;335552541&quot;:0,&quot;469769242&quot;:[65533,0],&quot;469777803&quot;:&quot;left&quot;,&quot;469777804&quot;:&quot;*&quot;,&quot;469777815&quot;:&quot;singleLevel&quot;}" data-aria-posinset="7" data-aria-level="1"><span style="font-style: inherit; font-weight: inherit;">Excellent organizational skills and ability to prioritize work.</span></li> <li style="font-style: inherit; font-weight: inherit;" data-leveltext="*" data-font="" data-listid="24" data-list-defn-props="{&quot;335551671&quot;:0,&quot;335552541&quot;:0,&quot;469769242&quot;:[65533,0],&quot;469777803&quot;:&quot;left&quot;,&quot;469777804&quot;:&quot;*&quot;,&quot;469777815&quot;:&quot;singleLevel&quot;}" data-aria-posinset="7" data-aria-level="1"><span style="font-style: inherit; font-weight: inherit;">Ability to manage multiple priorities and meet established deadlines.&nbsp;</span></li> <li style="font-style: inherit; font-weight: inherit;" data-leveltext="*" data-font="" data-listid="24" data-list-defn-props="{&quot;335551671&quot;:0,&quot;335552541&quot;:0,&quot;469769242&quot;:[65533,0],&quot;469777803&quot;:&quot;left&quot;,&quot;469777804&quot;:&quot;*&quot;,&quot;469777815&quot;:&quot;singleLevel&quot;}" data-aria-posinset="7" data-aria-level="1"><span style="font-style: inherit; font-weight: inherit;">Ability to perform mathematical calculations.&nbsp;</span></li> <li style="font-style: inherit; font-weight: inherit;" data-leveltext="*" data-font="" data-listid="24" data-list-defn-props="{&quot;335551671&quot;:0,&quot;335552541&quot;:0,&quot;469769242&quot;:[65533,0],&quot;469777803&quot;:&quot;left&quot;,&quot;469777804&quot;:&quot;*&quot;,&quot;469777815&quot;:&quot;singleLevel&quot;}" data-aria-posinset="7" data-aria-level="1"><span style="font-style: inherit; font-weight: inherit;">Excellent analytical and problem-solving skills.&nbsp;</span></li> <li style="font-style: inherit; font-weight: inherit;" data-leveltext="*" data-font="" data-listid="24" data-list-defn-props="{&quot;335551671&quot;:0,&quot;335552541&quot;:0,&quot;469769242&quot;:[65533,0],&quot;469777803&quot;:&quot;left&quot;,&quot;469777804&quot;:&quot;*&quot;,&quot;469777815&quot;:&quot;singleLevel&quot;}" data-aria-posinset="7" data-aria-level="1"><span style="font-style: inherit; font-weight: inherit;">Ability to use reference manuals.&nbsp;</span></li> <li style="font-style: inherit; font-weight: inherit;" data-leveltext="*" data-font="" data-listid="24" data-list-defn-props="{&quot;335551671&quot;:0,&quot;335552541&quot;:0,&quot;469769242&quot;:[65533,0],&quot;469777803&quot;:&quot;left&quot;,&quot;469777804&quot;:&quot;*&quot;,&quot;469777815&quot;:&quot;singleLevel&quot;}" data-aria-posinset="7" data-aria-level="1"><span style="font-style: inherit; font-weight: inherit;">Knowledge of medical terminology.&nbsp;</span></li> <li style="font-style: inherit; font-weight: inherit;" data-leveltext="*" data-font="" data-listid="24" data-list-defn-props="{&quot;335551671&quot;:0,&quot;335552541&quot;:0,&quot;469769242&quot;:[65533,0],&quot;469777803&quot;:&quot;left&quot;,&quot;469777804&quot;:&quot;*&quot;,&quot;469777815&quot;:&quot;singleLevel&quot;}" data-aria-posinset="7" data-aria-level="1"><span style="font-style: inherit; font-weight: inherit;">Knowledge of legal terminology.&nbsp;</span></li> <li style="font-style: inherit; font-weight: inherit;" data-leveltext="*" data-font="" data-listid="24" data-list-defn-props="{&quot;335551671&quot;:0,&quot;335552541&quot;:0,&quot;469769242&quot;:[65533,0],&quot;469777803&quot;:&quot;left&quot;,&quot;469777804&quot;:&quot;*&quot;,&quot;469777815&quot;:&quot;singleLevel&quot;}" data-aria-posinset="7" data-aria-level="1"><span style="font-style: inherit; font-weight: inherit;">Ability to comprehend various claims issues, address them or refer them for appropriate decision-making.&nbsp;</span></li> <li style="font-style: inherit; font-weight: inherit;" data-leveltext="*" data-font="" data-listid="24" data-list-defn-props="{&quot;335551671&quot;:0,&quot;335552541&quot;:0,&quot;469769242&quot;:[65533,0],&quot;469777803&quot;:&quot;left&quot;,&quot;469777804&quot;:&quot;*&quot;,&quot;469777815&quot;:&quot;singleLevel&quot;}" data-aria-posinset="7" data-aria-level="1"><span style="font-style: inherit; font-weight: inherit;">Ability to analyze details of workers' compensation claims and as a result able to make competent, independent decisions&nbsp;</span><span style="font-style: inherit; font-weight: inherit;">within authority.&nbsp;</span></li> <li style="font-style: inherit; font-weight: inherit;" data-leveltext="*" data-font="" data-listid="24" data-list-defn-props="{&quot;335551671&quot;:0,&quot;335552541&quot;:0,&quot;469769242&quot;:[65533,0],&quot;469777803&quot;:&quot;left&quot;,&quot;469777804&quot;:&quot;*&quot;,&quot;469777815&quot;:&quot;singleLevel&quot;}" data-aria-posinset="7" data-aria-level="1"><span style="font-style: inherit; font-weight: inherit;">Ability to work with minimal direction.&nbsp;</span></li> <li style="font-style: inherit; font-weight: inherit;" data-leveltext="*" data-font="" data-listid="24" data-list-defn-props="{&quot;335551671&quot;:0,&quot;335552541&quot;:0,&quot;469769242&quot;:[65533,0],&quot;469777803&quot;:&quot;left&quot;,&quot;469777804&quot;:&quot;*&quot;,&quot;469777815&quot;:&quot;singleLevel&quot;}" data-aria-posinset="7" data-aria-level="1"><span style="font-style: inherit; font-weight: inherit;">Ability to travel to locations outside of the office.&nbsp;</span></li> <li style="font-style: inherit; font-weight: inherit;" data-leveltext="*" data-font="" data-listid="24" data-list-defn-props="{&quot;335551671&quot;:0,&quot;335552541&quot;:0,&quot;469769242&quot;:[65533,0],&quot;469777803&quot;:&quot;left&quot;,&quot;469777804&quot;:&quot;*&quot;,&quot;469777815&quot;:&quot;singleLevel&quot;}" data-aria-posinset="7" data-aria-level="1"><span style="font-style: inherit; font-weight: inherit;">Ability to proofread documents for accuracy of spelling, grammar, punctuation, and format.&nbsp;</span></li> </ul> <p><span style="font-style: inherit; font-weight: inherit;">&nbsp;</span></p> <p><span style="font-style: inherit; font-weight: inherit;"><strong><strong style="font-style: inherit;">ADDITIONAL SKILLS/KNOWLEDGE/ABILITIES (SKA) REQUIRED FOR MOCS II:</strong></strong>&nbsp;<br /><br /></span></p> <ul style="font-style: inherit; font-weight: inherit;"> <li style="font-style: inherit; font-weight: inherit;" data-leveltext="" data-font="Symbol" data-listid="28" data-list-defn-props="{&quot;335552541&quot;:1,&quot;335559685&quot;:360,&quot;335559991&quot;:360,&quot;469769226&quot;:&quot;Symbol&quot;,&quot;469769242&quot;:[8226],&quot;469777803&quot;:&quot;left&quot;,&quot;469777804&quot;:&quot;&quot;,&quot;469777815&quot;:&quot;hybridMultilevel&quot;}" data-aria-posinset="1" data-aria-level="1"><span style="font-style: inherit; font-weight: inherit;">Demonstrated ability to use diplomacy, discretion, and appropriate judgment when responding to inquiries from staff and external customers as well as anticipating needs of the department.&nbsp;&nbsp;</span></li> <li style="font-style: inherit; font-weight: inherit;" data-leveltext="" data-font="Symbol" data-listid="28" data-list-defn-props="{&quot;335552541&quot;:1,&quot;335559685&quot;:360,&quot;335559991&quot;:360,&quot;469769226&quot;:&quot;Symbol&quot;,&quot;469769242&quot;:[8226],&quot;469777803&quot;:&quot;left&quot;,&quot;469777804&quot;:&quot;&quot;,&quot;469777815&quot;:&quot;hybridMultilevel&quot;}" data-aria-posinset="1" data-aria-level="1"><span style="font-style: inherit; font-weight: inherit;">Demonstrated ability to effectively exchange information clearly and concisely, and present ideas, report facts and other information and respond to questions as appropriate.&nbsp;</span></li> <li style="font-style: inherit; font-weight: inherit;" data-leveltext="" data-font="Symbol" data-listid="28" data-list-defn-props="{&quot;335552541&quot;:1,&quot;335559685&quot;:360,&quot;335559991&quot;:360,&quot;469769226&quot;:&quot;Symbol&quot;,&quot;469769242&quot;:[8226],&quot;469777803&quot;:&quot;left&quot;,&quot;469777804&quot;:&quot;&quot;,&quot;469777815&quot;:&quot;hybridMultilevel&quot;}" data-aria-posinset="1" data-aria-level="1"><span style="font-style: inherit; font-weight: inherit;">Knowledge of Workers' Compensation in one or more states including jurisdictional laws.&nbsp;</span></li> <li style="font-style: inherit; font-weight: inherit;" data-leveltext="" data-font="Symbol" data-listid="28" data-list-defn-props="{&quot;335552541&quot;:1,&quot;335559685&quot;:360,&quot;335559991&quot;:360,&quot;469769226&quot;:&quot;Symbol&quot;,&quot;469769242&quot;:[8226],&quot;469777803&quot;:&quot;left&quot;,&quot;469777804&quot;:&quot;&quot;,&quot;469777815&quot;:&quot;hybridMultilevel&quot;}" data-aria-posinset="1" data-aria-level="1"><span style="font-style: inherit; font-weight: inherit;">Knowledge of statutory standards in multiple states.&nbsp;</span></li> <li style="font-style: inherit; font-weight: inherit;" data-leveltext="" data-font="Symbol" data-listid="28" data-list-defn-props="{&quot;335552541&quot;:1,&quot;335559685&quot;:360,&quot;335559991&quot;:360,&quot;469769226&quot;:&quot;Symbol&quot;,&quot;469769242&quot;:[8226],&quot;469777803&quot;:&quot;left&quot;,&quot;469777804&quot;:&quot;&quot;,&quot;469777815&quot;:&quot;hybridMultilevel&quot;}" data-aria-posinset="1" data-aria-level="1"><span style="font-style: inherit; font-weight: inherit;">Demonstrated ability to negotiate, build consensus, and resolve conflict.&nbsp;</span></li> <li style="font-style: inherit; font-weight: inherit;" data-leveltext="" data-font="Symbol" data-listid="28" data-list-defn-props="{&quot;335552541&quot;:1,&quot;335559685&quot;:360,&quot;335559991&quot;:360,&quot;469769226&quot;:&quot;Symbol&quot;,&quot;469769242&quot;:[8226],&quot;469777803&quot;:&quot;left&quot;,&quot;469777804&quot;:&quot;&quot;,&quot;469777815&quot;:&quot;hybridMultilevel&quot;}" data-aria-posinset="1" data-aria-level="1"><span style="font-style: inherit; font-weight: inherit;">Demonstrated ability to manage multiple priorities and meet established deadlines.&nbsp;</span></li> <li style="font-style: inherit; font-weight: inherit;" data-leveltext="" data-font="Symbol" data-listid="28" data-list-defn-props="{&quot;335552541&quot;:1,&quot;335559685&quot;:360,&quot;335559991&quot;:360,&quot;469769226&quot;:&quot;Symbol&quot;,&quot;469769242&quot;:[8226],&quot;469777803&quot;:&quot;left&quot;,&quot;469777804&quot;:&quot;&quot;,&quot;469777815&quot;:&quot;hybridMultilevel&quot;}" data-aria-posinset="1" data-aria-level="1"><span style="font-style: inherit; font-weight: inherit;">Demonstrated ability to comprehend various claims issues, address them or refer them for appropriate decision-making.&nbsp;</span></li> <li style="font-style: inherit; font-weight: inherit;" data-leveltext="" data-font="Symbol" data-listid="28" data-list-defn-props="{&quot;335552541&quot;:1,&quot;335559685&quot;:360,&quot;335559991&quot;:360,&quot;469769226&quot;:&quot;Symbol&quot;,&quot;469769242&quot;:[8226],&quot;469777803&quot;:&quot;left&quot;,&quot;469777804&quot;:&quot;&quot;,&quot;469777815&quot;:&quot;hybridMultilevel&quot;}" data-aria-posinset="1" data-aria-level="1"><span style="font-style: inherit; font-weight: inherit;">Demonstrated ability to analyze details of workers' compensation claims and as a result able to make competent, independent decisions within authority.&nbsp;</span></li> <li style="font-style: inherit; font-weight: inherit;" data-leveltext="" data-font="Symbol" data-listid="28" data-list-defn-props="{&quot;335552541&quot;:1,&quot;335559685&quot;:360,&quot;335559991&quot;:360,&quot;469769226&quot;:&quot;Symbol&quot;,&quot;469769242&quot;:[8226],&quot;469777803&quot;:&quot;left&quot;,&quot;469777804&quot;:&quot;&quot;,&quot;469777815&quot;:&quot;hybridMultilevel&quot;}" data-aria-posinset="1" data-aria-level="1"><span style="font-style: inherit; font-weight: inherit;">Demonstrated ability to work with minimal direction.&nbsp;</span></li> </ul>