Technical Operator III

Key Responsibilities

• Review and analyze medical bills, treatment records, and claim documentation to determine appropriate settlement values.
• Negotiate with medical providers, and other parties to reach fair and timely resolutions.
• Ensure compliance with all applicable state workers’ compensation laws and regulations.
• Maintain accurate and up-to-date documentation of negotiations and outcomes in the claims management system.
• Identify potential cost-saving opportunities and work toward minimizing claim exposure.
• Communicate clearly and professionally with both internal and external contacts.
• Monitor claims to identify trends and report on potential areas of concern.

Qualifications

• 2–5 years of experience in workers’ compensation claims handling, bill review, or negotiation (or equivalent combination of education and experience).
• Strong knowledge of workers’ compensation regulations and fee schedules.
• Strong understanding of medical billing codes (CPT, ICD-10, HCPCS), state fee schedules, and PPO discounts
• Excellent communication and negotiation skills, both written and verbal
• Strong attention to detail and ability to manage multiple cases independently
• Excellent negotiation, communication, and analytical skills.
• Ability to work independently and manage multiple priorities in a fast-paced environment
• Proficient with claims management systems and Microsoft Office Suite.