Workers Compensation Integrated Specialist

JOB SUMMARY: 

The Work Comp Integrated Specialist coordinates care and claims activities for workplace injuries by scheduling medical services, obtaining treatment authorizations, and maintaining accurate claims records. This role serves as the primary liaison between injured employees, insurance carriers, case managers, third-party administrators, and clinical teams to ensure timely communication and resolution of claims-related issues. The position requires strong organization, attention to detail, independent decision-making, and the ability to manage multiple priorities in a fast-paced environment. 

KEY RESPONSIBILITIES: 

• Register new workplace injuries, update patient/employee demographics, and maintain accurate internal claims databases.  
• Able to act as a central liaison to schedule medical appointments, coordinate specialized care 
• Obtain required treatment and service authorization from adjusters, nurse case managers, or insurance carriers 
• Serve as the primary point of contact for injured workers, third-party administrators, legal counsel, and clinical teams.  
• Ability to work independently 
• Excellent written and verbal communication skills 
• Ability to multitask and prioritize effectively in a fast-paced environment. 
• Attention to detail and able to take initiative to resolve discrepancies with coding or claims issues. 
• Have a comprehensive knowledge of computer skills 
• Obtain written authorization and required documentation for service(s) from the insurance · carrier, case manager and/or employer· 
• Ensure updated authorization is documented in the system 
• Communicate with the patient advising of the scheduled appointment(s) 
• Handle incoming calls and triage to the respective departments as needed 
• Send required documentation to the carrier and/or case management as instructed 
• Reschedule bumped appointment(s), and notify the patient and carrier of the schedule change 
• Review a portion of claims prior to the submission to the insurance carrier(s)
• Works with the insurance carriers, third party and vendors to resolve payment and 
• authorization issues 
• Serves as an internal escalation point of contact for other departments as needed 

EDUCATION AND EXPERIENCE:  

• High school diploma or equivalent. 
• Experience: 2+ years of experience in workers' compensation administration, claims handling. 

PREFERRED QUALIFICATIONS & SKILLS:   

• An associate degree or certificate in medical billing and coding is highly preferred. 
• Software Proficiency: Hands-on experience with healthcare billing software and systems (e.g., Epic, eClinicalWorks, or Athena). 
• High data-entry speed and accuracy 
• Medical terminology familiarity, knowledge of commercial insurance and government policies (Medicare/Medicaid) 
• Precise analytical skills 
  
  

  ORTHOPAEDIC SOLUTIONS MANAGEMENT IS A DRUG FREE WORKPLACE 

    

  We are committed to maintaining a safe, healthy, and productive work environment. As part of this commitment, we operate as a drug-free workplace. All candidates will be required to undergo pre-employment drug screening and/or be subject to random drug testing in accordance with applicable laws and company policy. 

    

  Equal Employment Opportunity & Work Force Diversity 

   

   Our organization is an equal opportunity employer and will not discriminate against any employee or applicant for employment based on race, color, creed, sex, religion, marital status, age, national origin or ancestry, physical or mental disability, medical condition, parental status, sexual orientation, veteran status, genetic testing results or any other consideration made unlawful by federal, state or local laws.  This practice relates to all personnel matters such as compensation, benefits, training, promotions, transfers, layoffs, etc.  Furthermore, our organization is committed to going beyond the legal requirements of equal employment opportunity to take positive actions which ensure diversity in the workplace and result in a multi-cultural organization.