Claims Specialist

Claims Specialist

This position can be filled out of Cheyenne or Gillette

General Description: The Wyoming Department of Workforce Services is seeking a detail-oriented and analytical Claims Specialist to join its Workers' Compensation team.

In this role, you will perform comprehensive case management functions for assigned employer accounts, ensuring the timely and accurate handling of Workers' Compensation claims. Responsibilities include determining the compensability of claims based on statute and policy, reviewing documentation, analyzing facts, and making sound, well-supported decisions.

The position also monitors claims activity for potential fraud, abuse, or other improprieties, helping safeguard the integrity of the Workers' Compensation program. This role requires strong critical thinking skills, attention to detail, and the ability to communicate clearly and professionally with employers, injured workers, medical providers, and other stakeholders.

If you are committed to public service and take pride in ensuring fair, consistent, and accountable claims administration, we encourage you to apply.

Working for the State of Wyoming offers more than a paycheck. Our total compensation package includes:

• Comprehensive health, dental, and vision insurance
• Paid vacation, sick leave, FMLA and holidays
• Retirement - Pension and 457B plans that help you build a secure future
• Flexible schedules and work-life balance options
• Meaningful work that makes a difference for Wyoming communities and MUCH MORE!

Human Resource Contact: View email address on click.appcast.io

Essential Functions: The listed functions are illustrative only and are not intended to describe every function that may be performed at the job level.

• Use case management skills to guide customers through the Workers' Compensation benefits program.
• Review injury reports.
• Investigate the circumstances of the injury.
• Make eligibility determinations on the claim for benefits by reviewing applications and medical reports.
• Process claims for indemnity benefits.
• Communicate clearly the rights, responsibilities, and benefits of the Workers' Compensation program.
• Assist injured workers with filing requirements and understanding the complex claims processes.
• Refer appropriate cases for hearing and may provide testimony in the hearings.
• Respond directly to employers or vendors in regard to questions on procedures or the status of cases or claims.
• Coordinate return to work and work restrictions with healthcare providers and employers.
• Analyze medical documentation to determine the compensability of claims.
• Initiate and monitor program requirements and process benefits.
• Mediate disputes involving injured workers, employers, healthcare providers, and the division.
• Coordinate with healthcare providers to effectively manage the compensable injury and establish appropriate diagnoses and treatment plans for the injury.

Preferences: Preference may be given to those with Claims Management and/or Claims Service experience. Preference may be given to those with Customer Service experience. Preference may be given to those with a Bachelor's degree in Management and/or Social Services.

Knowledge: Knowledge of Workers' Compensation Law and Rules & Regulations. Ability to assist clients in working through complex processes. Ability to work independently. Ability to analyze situations and provide resolutions within the statutes. Knowledge of medical terminology. Knowledge of case management. Knowledge of customer service.

Minimum Qualifications: Education: Bachelor's Degree Experience: 0-1 year of progressive work experience (typically in Benefits and Eligibility) OR Education & Experience Substitution: 3-4 years of progressive work experience (typically in Benefits and Eligibility) Certificates, Licenses, Registrations: None

Necessary Special Requirements: FLSA: Non-Exempt. Former State of Wyoming employees who are rehired less than 31 days after their final day in their old agency must repay all leave payouts. The Wyoming Department of Workforce Services (DWS) uses E-Verify, an Internet-based system, to confirm the eligibility of all newly hired employees to work in the United States. Learn more about E-Verify, including your rights and responsibilities. For the Veteran's preference consideration, supporting documentation must accompany your application. Offers of employment will be contingent upon the successful completion of a background check.