Workers' Compensation Resolution Specialist II

Workers' Compensation Resolution Specialist II About the Role The Workers' Compensation (WC) Resolution Specialist II’s primary responsibility is to manage and resolve accounts/cases associated with workers' compensation claims in outstanding AR greater than 1 year. This role demands a strong understanding of workers' compensation regulations, excellent negotiation skills, and the ability to collaborate with multiple stakeholders. An additional objective is analyzing and preparing cases for the possibility of litigation. This position includes compliance with HIPAA, state and federal document security regulations. Specialists receive advanced training in workers’ compensation laws, regulations, and copy service fee schedules related to all aspects of billing, collections, objections, and the regulatory landscape specifically related to copy service fees. The WC Resolution Specialist II will also be involved in mentoring, training, and assisting other departments in the understanding of workers compensation as a whole and copy service as an individual area of specialty. Location and Compensation Location: West Covina, CA or Rocklin, CA / Remote-Hybrid Schedule: Monday-Friday, 8:00am-5:00pm Compensation: $26.44-$33.17 per hour (starting pay typically within lower third of range) Responsibilities Review, assess, and analyze cases associated with workers' compensation claims to determine their validity and accuracy. Conduct comprehensive research and gather necessary documentation to support negotiations and resolutions. Negotiate with claims adjusters, lien resolution specialists, defense attorneys, and other relevant parties to reach fair and reasonable settlements. Ensure compliance with all relevant workers' compensation laws, regulations, and guidelines in lien resolution activities. Maintain effective communication with various stakeholders, including claims adjusters, attorneys, lien units, clients, and internal stakeholders to update them on the progress of case resolution. Maintain detailed records of all resolution activities, including agreements, payments, and any relevant correspondence. Create and maintain detailed analysis of cases in preparation for litigation. Record keeping of payments pursuant to settlement agreements and correspondence with a guarantee of payment. Handle any disputes or conflicts related to lien resolution in a professional and diplomatic manner. Identify opportunities to minimize costs associated with resolution of cases while upholding legal and ethical standards. Stay updated on changes in workers' compensation laws and regulations, and attend training sessions or workshops as necessary. May handle collections of the Voucher and/or Civil AR, requiring basic workers’ compensation knowledge related to vouchers. Other duties as required. Qualifications High school diploma or equivalent required. 3+ years of experience in the workers’ compensation field required. Typing speed of at least 35 WPM with 90% accuracy. In-depth understanding of workers' compensation statutes, regulations, and case law. Ability to collaborate with multiple stakeholders. Comprehensive skills in process writing and flow chart mapping. Exceptional ability to effectively negotiate. Excellent verbal and written communication skills, including proof‑reading, syntax, and grammar. General computation skills, including the use of a calculator. Proficient using a computer, business phone, office software, video conferencing, and other computer programs including Google Workplace and Microsoft applications. Ability to complete data entry with a high level of accuracy. Functional Requirements Sitting for at least one hour at a time (total: 4-6 hours/day). Keyboarding for extended periods of time (total: 4-6 hours/day). Using a phone with or without a headset for extended periods (total: 3-5 hours/day). Benefits Comprehensive medical, dental, and vision coverage. Generous paid time off, including PTO, sick leave, volunteer time, and paid holidays. 401(k) plan with company match. Employee Assistance Program and legal assistance benefit. Company-paid annual charitable donation in your name. #J-18808-Ljbffr Gemini, Inc.