[Hiring] Workers Compensation Claims Analyst @Transcend Health Solutions

Role Description

• Review and process WC claims by gathering medical records, itemized bills, and employer/patient information.
• Submit claims to WC carriers in accordance with state-specific statutes and billing rules.
• Verify eligibility, claim status, and payer responsibility with adjusters and employers.
• Communicate professionally with insurance adjusters, employers, and patients to resolve claim barriers and expedite processing.
• Review Explanation of Benefits (EOBs) or remittance advices for accuracy and next steps.
• Prepare and submit appeals when claims are denied or underpaid, referencing applicable WC rules and documentation.
• Ensure all activities are documented clearly and timely in claim management systems.
• Maintain compliance with HIPAA and confidentiality standards.
• Escalate complex claim issues or legal barriers to leadership as needed.
• Meet productivity goals while maintaining excellent attendance, attention to detail, and accuracy.

Qualifications

• Expert knowledge of WC claims processes, including writing effective appeals and reconsiderations.
• Strong knowledge of medical terminology, coding (ICD-10, CPT, HCPCS), and healthcare billing principles.
• Excellent communication and problem-solving skills.
• Strong working knowledge of workers' compensation statutes and regulations in multiple states (e.g., FL, GA, AL, OK, MO, TX).
• Experience handling WC claims from submission through resolution.
• Proficiency in interpreting EOBs, state fee schedules, and medical documentation.
• Ability to communicate clearly and professionally with adjusters, employers, patients, and healthcare providers.
• Highly organized and detail-oriented with excellent follow-up skills.
• Proven track record of excellent attendance and reliability.
• High School Diploma required; Bachelor’s degree preferred, or equivalent combination of education and experience.
• Minimum of 2 years’ experience in WC claims, medical billing, or claims resolution.

Preferred Skills

• Familiarity with WC-specific portals (e.g., Georgia SBWC, Corvel, Georgia DOL, etc.)
• Experience with hospital lien filing and coordination of benefits.
• Proficiency in Microsoft Office.
• Knowledge of medical terminology and ICD-10/CPT coding.
• Understanding of WC authorization and referral processes.
• EHR experience.