Urgent Need Program Assistant 2 / Worker’s Compensation Specialist - Madison, WI (Onsite)

Position Summary

The Worker's Compensation Specialist will review and resolve healthcare cost disputes involving medical services and pharmacy charges related to workplace injuries. The position will also prepare treatment-necessity disputes for expert review and provide technical and administrative support concerning workers compensation claims and procedures.

Key Responsibilities

• Review and analyze medical cost disputes for completeness.
• Verify that disputes are associated with active workers compensation claims.
• Enter and maintain dispute information in claims databases, health-cost systems, and Excel.
• Obtain supporting information from employers, insurance carriers, injured employees, attorneys, and medical providers.
• Use healthcare fee databases to identify certified fee information.
• Calculate appropriate medical payment amounts.
• Draft orders directing insurance carriers or employers to pay certified amounts.
• Research pharmacy fee-schedule disputes and prepare final orders.
• Apply applicable Wisconsin statutes, administrative rules, and agency procedures.
• Review treatment-necessity disputes and determine whether cases are ready for expert review.
• Compile medical and claim documentation for submission to private medical experts.
• Respond to questions from injured workers, employers, insurance carriers, attorneys, and healthcare providers.
• Conduct informal conferences and interviews with disputing parties.
• Maintain accurate case-status documentation and recommend process improvements.

Required Knowledge and Skills

• Effective written and verbal communication skills.
• Customer service experience.
• Investigative and fact-finding skills.
• Knowledge of dispute-resolution and conflict-resolution techniques.
• Strong analytical and problem-solving abilities.
• Knowledge of medical terminology.
• Familiarity with healthcare procedure coding.
• Proficiency with computers, databases, imaging systems, and Microsoft Excel.
• Basic mathematical skills for payment calculations.
• Ability to read, interpret, and apply statutes and administrative rules.
• Ability to review medical reports, claim documents, and factual materials.
• Ability to make objective decisions in complex or disputed situations.
• Ability to work effectively with coworkers, agency personnel, and members of the public.