Workers’ Compensation Resolution Specialist I

The Workers’ Compensation (WC) Resolution Specialist I is responsible for managing and resolving workers’ compensation claims with an outstanding adverse response (AR) greater than one year. This role requires a strong understanding of workers’ compensation regulations, excellent negotiation skills, and the ability to collaborate with multiple stakeholders. An additional responsibility is analyzing and preparing cases for the possibility of litigation. The position includes compliance with HIPAA and state and federal document security regulations. Specialists receive advanced training in workers’ compensation laws, regulations, and copy service fee schedules for all aspects of billing, collections, objections, and regulatory compliance related to copy service. Employees of Gemini Legal Support may be exposed to confidential, private or sensitive information, protected under HIPAA. Location & Schedule Location: West Covina, CA or Rocklin, CA / Hybrid-Remote Schedule: Monday‑Friday, 8:00 am‑5:00 pm Compensation: $24.04 – $30.77 per hour 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 payment 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. Experience, Skills & Abilities High School diploma or equivalent is required. 1–3 years of experience in the workers’ compensation field. Typing speed of at least 35 WPM with 90 % accuracy. Understanding of workers’ compensation regulations. Ability to collaborate with multiple stakeholders. Comprehensive skills in process writing and flow chart mapping. Ability to effectively negotiate. Excellent verbal and written communication skills, including proofreading, 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 Workspace (Docs, Sheets, Calendar, Gmail, etc.) 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. Tuition reimbursement program. Employee Assistance Program and legal assistance benefit. Company‑paid annual charitable donation in your name. Employee recognition program. #J-18808-Ljbffr