Orthopedic Surgery Workers Compensation Specialist

Overview Position: Orthopedic Surgery Workers Compensation Specialist Under direct supervision, the Worker’s Compensation Specialist (WCS) provides clerical and administrative support to orthopedic patients with workers’ compensation injuries. The WCS processes data, generates routine reports, and supports claim representatives and patients. The role also maintains office records, appointments, and calendars, and may involve answering telephones, facilitating communications among stakeholders, assisting with peer reviews, filing, mail processing, document scanning, preparing letters and medicolegal documents, and surgical pre-authorizations. Responsibilities Develop, maintain, and manage the internal workers’ compensation program. Investigate and process workers’ compensation claims from initial evaluation to surgical and discharge phases. Communicate with employees, managers, insurance carriers, medical providers, surgeons, attorneys, and management regarding workers’ comp issues. Collaborate with Billing Director to respond to claim investigations, settlements, and litigations. Maintain timely communication loops regarding claims processing, status, and denials. Assist patients with reporting workplace injuries promptly. Schedule and manage appointments (routine follow-ups, IMEs, etc.) and assist Medical Providers with scheduling depositions, court appearances, etc. Update internal workers’ compensation database weekly and produce monthly active case reports. Handle claim investigations, settlements, and litigation issues; communicate updates to all parties. Work within applicable workers’ compensation laws and requirements for accommodations, restrictions, and return-to-work. Obtain verification, pre-certification, pre-authorization, and authorization for scheduled tests and procedures as needed. Assist with scheduling surgeries, imaging diagnostics (MRI, CT, X-ray, EMG/NCS, Bone Density, etc.), pre-op clearance, referrals, and related items. Contact insurance or legal representatives to confirm client information and appointments. Serve as the main point of contact for all injured patients with active WC cases. Act as liaison between physicians, insurance carriers, and legal representatives; inform patients about appointment and/or surgery approval status. Communicate promptly and clearly with attorneys, adjusters, physicians, patients, and staff. Adhere to BMC’s RESPECT behavioral standards. Qualifications Education : Associate degree in a Business/Legal-related field required; Bachelor’s degree preferred. Experience : Minimum of three years of clerical and insurance management experience. At least one year of workers’ compensation adjuster or case manager experience preferred. Experience in an Orthopedic clinical setting is a plus. Workers’ Compensation Analyst certification is preferred but not required. Knowledge and Skills : Knowledge of administration of workers’ compensation program and applicable laws. Ability to interpret, explain, and disseminate information to individuals and groups. Effective communication and interpersonal skills. Strong organizational, analytical, and problem solving abilities. Ability to develop spreadsheets, databases, PowerPoint, and Word documents. Knowledge of basic accounting principles; ability to work with external parties and coworkers. Ability to present information in one-on-one and small group settings. Ability to coordinate multiple projects with changing priorities and to meet deadlines. Ability to work independently and collaboratively with strong customer service. Compensation and Benefits Compensation Range : $25.48 - $37.02 per hour. Range reflects minimum qualifications; final offer based on education, experience, skills, and certifications/licensures, as well as organizational needs and market considerations. BMCHS also offers comprehensive benefits including medical, dental, vision, pharmacy, paid time off, and retirement contributions, among others. Additional Information Equal Opportunity Employer : Boston Medical Center is an equal employment/affirmative action employer. We provide equal opportunities regardless of race, color, religion, sex, national origin, age, disability, veteran status, sexual orientation, gender identity and/or expression, or any other non-job-related characteristic. If you need accommodation for any part of the application process due to a medical condition or disability, please email View email address on click.appcast.io or call View phone number on click.appcast.io. Compliance and Security : Boston Medical Center participates in the Electronic Employment Verification Program. E-Verify is used for background checks. COVID-19 and flu vaccinations, plus a booster, may be required as part of employment. The organization advises that current job openings are listed on our official website and applications are processed through our site. We do not request upfront downloads of applications or engage in app-based offers via text or social media. To avoid employment scams, review FTC guidance on tips for avoiding scams. Boston Medical Center is an equal employment/affirmative action employer. We provide equal opportunities for all and support a diverse, inclusive workforce. #J-18808-Ljbffr Boston Medical Center