Administrative Assistant II — Workers’ Compensation Health Cost Disputes

Position Summary: Provide professional and administrative support for workers compensation health cost disputes. Review disputes concerning medical fees, pharmacy charges, and treatment necessity; prepare cases and draft orders; maintain claim records; and assist parties with workers compensation questions and procedures.

Location: 201 E. Washington Ave., Madison, WI 53703

Responsibilities

• Review incoming medical cost disputes for completeness, including supporting medical charges and payment denials.
• Enter and track disputes in Excel and claims databases, associate disputes with existing claims, and initiate claim records when necessary.
• Obtain additional information from employers, insurance carriers, employees, attorneys, and healthcare providers.
• Research certified medical fees and draft payment orders consistent with Wisconsin statutes, administrative rules, and division guidelines.
• Research pharmacy fee disputes and prepare draft final orders for review and signature by authorized officials.
• Review treatment necessity disputes, clarify disputed issues, and compile case materials for expert review.
• Notify parties when health cost disputes are on hold pending litigation.
• Maintain accurate records of case progress and actions.
• Answer technical questions about workers compensation laws and procedures by telephone and written correspondence.
• Support informal dispute conferences and recommend improvements to policies and procedures.

Knowledge, Skills, and Abilities

• Knowledge of medical terminology and healthcare procedure coding.
• Knowledge of investigative methods, customer service, and dispute resolution.
• Ability to read, interpret, and apply statutes and administrative rules.
• Ability to review medical reports and other supporting documents.
• Proficiency with Excel, computer databases, and document imaging systems.
• Strong written and verbal communication, problem solving, and conflict resolution skills.
• Basic mathematical skills for payment calculations.
• Ability to exercise sound judgment, work with diverse parties, and maintain cooperative working relationships.

Assignment Requirements

• Wisconsin Department of Justice criminal background check before work begins.
• Display an agency-provided photo identification badge.