Occupational Health Service Representative

About the Role

Under indirect supervision, maintains patient/employer relationships related to industrial/occupational, workers compensation, and no-fault inquiries. Compiles and reports department statistics, communicates, monitors, and processes insurance claims, reports, and billing. Coordinates and processes monthly physician schedules, schedules and registers patients, and provides clerical support while adhering to compliance and confidentiality standards.

Responsibilities

• Obtains and provides industrial/occupational medical information, advice, or explanations to patients or employers regarding benefits, applications, status, eligibility, form filing, and time limits.
• Communicates with Kaiser personnel in other departments (e.g., Diagnostic Imaging, outlying clinics, Industrial Insurance, and Risk Management) to ensure proper handling and completion of claim requests.
• Assists in new patient/employee orientation; verifies patient benefits and interprets rules and regulations of health plans, workers compensation, and no-fault insurance.
• Reviews and triages requests for medical information, visit records, insurance billing forms, and other documents for completeness and accuracy; maintains industrial/occupational clinic documentation.
• Facilitates referral processes, coordinates prior approvals from insurance carriers, tracks follow-ups, and ensures completion of required documentation.
• Maintains current departmental files and operates standard office equipment.
• Handles inquiries and complaints pertaining to patient care issues; refers complex issues to supervisors as needed.
• Inputs and updates patient information in the SIM system daily for OHS, workers compensation, no-fault, and pre/post-encounter cases.
• Prepares and adjusts monthly physician calendars/appointment schedules; coordinates physician activities such as meetings and depositions.
• Communicates with insurance carriers, employers, doctors, patients, attorneys, and others to exchange information regarding workers compensation injury claims.
• Audits patient medical records, visit records, and fee schedules to process insurance claims and reports in compliance with regulations and policies.
• Provides ongoing assistance and information to claimants, insurance carriers, attorneys, and providers while ensuring patient confidentiality.
• Reconciles discrepancies with various departments, maintains control logs, and ensures correct computer data processing.
• Prepares departmental revenue statistics and reviews source documents related to utilization data.
• Implements patient and employee education activities regarding industrial procedures, policies, and claims.
• Registers industrial and no-fault patients, obtains medical information, and prepares patient data in the SIM system.
• Demonstrates culturally sensitive care and performs other duties as assigned.

Requirements

• Two (2) years of experience in customer relations, public relations, workers compensation, or a related field.
• High School Diploma or equivalent combination of education and experience.
• Knowledge of workers compensation laws and state/federal regulations.
• Knowledge of medical terminology.
• Typing speed of 30 wpm.
• Proficiency in word processing, spreadsheet, and database PC applications.
• Strong skills in adaptability, conflict resolution, decision making, customer service, interpersonal relations, oral and written communication, problem solving, and teamwork.

Preferred Qualifications

• Knowledge of statistics.
• 10-key by touch.
• Post-high school coursework in business and medical assistance.

Schedule

• Full-time, 40 hours per week.
• Shift: Day (08:00 AM – 05:00 PM).
• Workdays: Monday, Tuesday, Wednesday, Thursday, Friday.
• Worker location: Onsite.
• Travel: Up to 25% of the time.

Pay

$26.74 - $29.71 per hour. Kaiser Permanente offers a market-competitive total rewards package, with pay determined based on labor market data, internal alignment, and candidate qualifications.