Workers Compensation Claims Specialist

Position Overview
The Workers Compensation Claims Specialist is responsible for the being the liaison between the Aveanna Field Staff and the third party administrator. This role will require investigation of claims and insurance that our third party administrator is managing the claims in an effect manner. This position will resolve claims according to Best Practices and within authority limits by following established protocols to ensure that claims are handled in the most efficient, effective way while delivering excellent customer claims service.

Essential Job Functions
Investigating, reviewing, evaluating, and administering workers' compensation claims
Reviewing medical reports
Setting reserves
Filing documentation
Reviewing and approving medical bills for payment
Reviewing accident and injury reports
Interviewing and correspond with claimants, witnesses, attorneys, and physicians
Approving claims or recommending denial
Representing Aveanna at various workers' compensation and industrial leave claims actions and hearings
Perform other duties as assigned

Requirements
High School Diploma and 5 years or more experience in Claims and Litigation OR a Bachelor’s Degree and 4 years’ experience in Claims and Litigation
Knowledge of claims handling and legal statutes and procedures
Customer service experience
Workers Comp experience in California, Texas, and Pennsylvania and non-subscriber claim experience highly preferred

Other Skills/Abilities
Attention to detail
Time Management
Effective problem-solving and conflict resolution
Good organization and communication skills

Physical Requirements
Must be able to speak, write, read and understand English
Occasional lifting, carrying, pushing and pulling of 25 pounds
Prolonged sitting, walking, standing, bending, kneeling, reaching, twisting
Must be able to sit and climb stairs
Must have visual and hearing acuity
Must have strong sense of smell and touch

Environment
Performs duties in an office environment during agency operating hours
Must be able to function in a wide variety of environments which may involve exposure to allergens and other various conditions

Other Duties
Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice.

Vaccination Requirement
As an employer accepting Medicare and Medicaid funds, employees must comply with all health-related requirements in all relevant jurisdictions, including required vaccinations and testing, subject to exemptions for medical or religious reasons as appropriate.

Headhunters and recruitment agencies may not submit resumes/CVs through this website or directly to managers. Aveanna does not accept unsolicited headhunter and agency resumes, and will not pay fees to any third-party agency or company that does not have a signed agreement with Aveanna.

As an employer accepting Medicare and Medicaid funds, employees must comply with all health-related requirements in all relevant jurisdictions, including required vaccinations and testing, subject to exemptions for medical or religious reasons as appropriate.

Notice for Job Applicants Residing in California