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Paragon Technical Services, Inc.
Case Worker -- (DOL Medical Compensation Program)
Career Insights for Medical Claims Processor / Representative
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Based on South Carolina data
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What they do
A Medical Claims Processor or Representative reviews and processes medical insurance claims and determines whether an insurance policy will cover a medical procedure. Gathers information from policy holders and organizes insurance files; may process checks with payments to policy holders when a medical claim is approved.
$45,209 / year median in South Carolina
-3% projected decline
Job Description
Case Worker -- (DOL Medical Compensation Program) Paragon Technical Services, Inc. North Augusta, SC Job Details Full-time From $33 an hour 3 hours ago Benefits Health savings account Health insurance 401(k) Paid time off 401(k) matching Qualifications Computer operation Insurance products customer support Data privacy management Interpersonal skills Phone communication Copy machines Service scheduling In-person customer service Scanning Research Workers' compensation insurance knowledge Attention to detail Telephone systems Multi-line phone systems Typing Productivity software Grammar Experience Medical terminology Customer interaction during outreach Office phone management Quality data entry
Full Job Description Job Title:
Energy Employees Medical Compensation Program Caseworker Opening Period:
Until filledPosition Information:
Project-specific position with full-time hours and optional benefitsDuty Location:
N. Augusta, SC The Resource Center Caseworker is responsible for the provision of program-related information and claims-related assistance to claimants and potential claimants applying for benefits under the Energy Employees Occupational Illness Compensation Program (EEOICP) Act of 2000. This program supports the Department of Labor in compensating former Department of Energy employees who suffer from certain illnesses because of their employment in the Department of Energy complex. Caseworkers work directly with claimants and their families to provide assistance in navigating through the complex compensation program process. This involves working with claimants and making visits to hospitals/nursing homes/hospice care facilities or claimant homes to provide assistance as needed. The compensation program has various elements that provide lifetime benefits to claimants; therefore, Caseworkers can often assist specific individuals for several years. Major Responsibilities of theCaseworker:
- Assist potential claimants in collecting the required information by directing them to potential sources of the required information, i.e., labor unions, etc.
- Assist in the completion of claim forms
- Collect and compile all claim-related data necessary into government databases
- Work directly with claimants in reporting occupational history information and assist in resolving medical billing issues
- Handle incoming toll-free calls from individuals requesting information about the program or needing assistance with their claim. Provide assistance as needed and document the specifics of the call.
- Assist medical providers with enrollment in the EEOICP
- Conduct outreach to potential claimants
Requirements and Qualifications:
(Candidates must meet ONE of the numbered requirements below) 1. At least 3 years' experience providing assistance for a federal, private or state workers' compensation program 2. Working at or for a Department of Energy facility covered by the program. 3. Working for a private medical insurance company directly handling client insurance needs. 4. Working in a case management position with a Home Health Care company, social work entity, or similar organization providing direct care to individuals. 5. Working as a medical provider, to include Medical Doctor, Nurse, medical technology specialist, or in a position that provided direct medical care to patients. 6. Working in medical claim reporting/billing using the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) system of diagnosis codes. 7. Working in Environmental Sciences, Radiological Control, Safety and Health, Industrial Hygiene/Health Physics, or Chemical Exposures classifications. 8. Is a U.S. military veteran, honorably discharged, having the capability and aptitude deemed relevant to being a successful Case Worker. Other required skills and experience includes:- At least 2 years' experience with customer service skills, over the phone and in person, with customers and internal departments.
- Proven research and analytical skills.
- Proven knowledge of employment and medical records verification techniques.
- Proven ability to implement the Privacy Act.
- Proven ability to maintain a scheduling assignment process that ensures individuals are assisted quickly and efficiently and are not subject to prolonged waits during either in person appointments or telephone calls.
- Strong sense of urgency, problem solving skills, and attention to detail.
- Exceptional verbal and written communication skills including spelling, grammar and pronunciation of complex medical terminology.
- Exceptional organizational skills and ability to multi-task.
- Basic office/computer skills including: o Microsoft Office including Word/word processing, database software o Data entry with a high level of accuracy o Minimum typing speed of 40 words per minute o Multi-line phone system o General office equipment including scanning, saving and organizing documents electronically, photocopying, troubleshooting
- Bachelor's degree or equivalent preferred.