Workers Compensation Specialist (Human Resource Specialist I)
Job ID: 16280
Agency: Bureau of Human Resources - Workers Compensation
Salary: $18.36 - $20.66 per hour, depending on experience
Pay Grade: GG
Closing Date: Open Until Filled
This is a Full-Time 40 Hours Weekly position with the Bureau of Human Resources. For more information on the Bureau of Human Resources, please visit http://bhr.sd.gov .
The State of South Dakota manages Workers' Compensation benefits for all state employees. The program is responsible for intake of First Reports of Injury, determining compensability, processing medical claims for employees, coordinating care, and processing lost wage payments. The specialist is the main point of contact for the employee and medical providers to answer questions on how the program works.
The Ideal Candidate Will Have:
E ducation/training in a health care environment and medical review process would be beneficial .
- work both independently and as a team to ensure timely determination and coordination of Workers' Compensation benefits;
- conduct timely and thorough review of First Reports of Injury;
- determine benefits due the employee, including accurate calculation of lost wage benefits and medical services;
- work between multiple systems to process claims, document work notes, process payments, and approve medical bills;
- determine and implement effective and timely communications with employees, medical providers and other involved parties to ensure coordination of medical treatment, benefits and status of claim;
- review and approve payments for medical treatment with state guidelines;
- timely document all work activity in claims software system;
- participate in claim review meetings with supervisor and/or other staff;
- troubleshoot various issues related to the management of claims;
- make decisions regarding compensability after completing an investigation;
- comprehend and apply multiple state laws, procedures and changes to same, as applicable to management of claims;
- communicate effectively, both orally and in written form, with injured employees, medical providers, and vendors;
- prioritize work load;
- analytic thinking;
- accurate data entry.
VETERANS' PREFERENCE ELIGIBLE
NCRC: If you possess a National Career Readiness Certificate, please submit the certificate with your application. For more information on how to acquire a National Career Readiness Certificate contact a South Dakota Department of Labor and Regulation Job Service Office. A certificate is not necessary to be considered.
The State of South Dakota does not sponsor work visas for new or existing employees. All persons hired will be required to verify identity and eligibility to work in the United States and complete an Employment Eligibility Verification, Form I-9. The State of South Dakota as an employer will be using E-Verify to complete employment eligibility verification upon hire.
The State of South Dakota offers employer paid health insurance plus ten paid holidays, generous vacation and sick leave accrual, dental, vision, and other insurance options, and retirement benefits. You can view our benefits information at https://bhr.sd.gov/job-seekers/work-for-state-government/ . This position is a member of Class A retirement under SDRS.
Must apply online: https://sodakprod-lm01.cloud.infor.com:1443/lmghr/xmlhttp/shorturl.do?key=E69
You must apply online, emailed resumes or submissions will not be accepted.
South Dakota Bureau of Human Resources
Telephone: 605.773.3148 Email: email@example.com
"An Equal Opportunity Employer"