- Workers' Compensation Technician II
- What will I be doing?
- Do I qualify?
- Can I be successful?
- How do I apply?
This is mid-level technical work in the Care Unit of the Missouri Division of Workers' Compensation involving independently securing and evaluating information required for processing Claims for Compensation, First Reports of Injury, and ancillary documents.
Reviews and evaluates new information received for complex, contested, and amended claims, bankruptcies, relocated insurance companies, third party administrators, and employers; documents detailed information regarding separation from work, multiple employers, and insurers pled on contested cases.
Processes complex Claims for Compensation, Answers to Claims, Entries of Appearance by attorneys, lost wage information, medical costs and medical records, and any other legal documents associated with the underlying workers' compensation case.
Downloads electronic files from external computer sources and reviews to determine the validity of the information; determines if the quality of the data is acceptable or if it should be returned to the reporting entity for correction.
Verifies data through large external databases maintained by agencies such as the National Council on Compensation Insurance, Internal Revenue Service (IRS), Employment Security, Department of Insurance, Finance and Professional Registration, and Department of Revenue; contacts personnel at these agencies and organizations to verify and obtain data.
Identifies information that does not conform to the Trading Partner Agreement and statutory requirements.
Investigates, identifies, and corrects information or requests additional information from the stakeholders.
Identifies cases that need immediate attention and refers to the adjudication staff for a docket setting.
Verifies licensure of third party administrators and insurance carriers; determines if attorneys are properly credentialed to practice law in the state of Missouri.
Receives and answers telephone calls and written correspondence regarding complex and contested cases.
Identifies potential fraudulent activities and reports to the supervisor for referral to the Fraud and Non Compliance Unit; determines when the insurer has met the criteria for notification or referral to the Attorney General's office.
Trains, assists, and mentors employees in lower classifications during their probationary and training periods.
Develops and maintains Excel spreadsheets regarding death cases, non-compliant reporting entities, and other issues that must be monitored routinely.
Resolves disputed claim issues in compliance with statutes, regulations, policies, and procedures.
Collaborates with supervisors, administrators, and management, including the Division's Chief Legal Counsel, to resolve very complex claims issues.
Receives general supervision; however, the employee is expected to work independently in the performance of assigned responsibilities within established guidelines.
Performs other related work as assigned.
(The following minimum qualifications will determine merit system eligibility. Allowable experience and education substitutions are provided in italics below the corresponding minimum qualification statement. These minimum qualifications may also be used to evaluate applicants for Missouri Uniform Classification and Pay System positions not requiring selection from merit registers.)
One or more years of experience as a Workers' Compensation Technician I with the Missouri Division of Workers' Compensation; and possession of a high school diploma or proof of high school equivalency.
Four or more years of office experience including two or more years of technical experience processing workers' compensation or insurance claims; and possession of a high school diploma or proof of high school equivalency.
(Training from an accredited vocational or business school in Office Management, Secretarial Science, or a closely related area may substitute on a year-for-year basis for a maximum of one year of the required general experience at a rate of 30 earned credit hours, or 480 clock hours for one year.)
(Earned credit hours from an accredited college or university may substitute on a year-for-year basis for the required general experience at a rate of 30 earned credit hours for one year.)
Please note that documentation that supports your eligibility (i.e. transcripts, employment records, etc.) may be required at any time during the application and hiring process. If you do not possess the minimum qualifications, please consider one of many other employment opportunities with the State of Missouri.
Do you possess the key skills which are considered essential for successful employment in this classification?
Intermediate knowledge of state laws and regulations governing the processing and adjudication of Workers' Compensation claims.
Intermediate knowledge of the policies, procedures, and operations of the Division of Workers' Compensation.
Intermediate knowledge of the computer systems utilized in the Division of Workers' Compensation.
Intermediate knowledge of relational database case management applications.
Intermediate knowledge of Workers' Compensation claims processing.
Intermediate knowledge of basic legal and medical terminology .
Intermediate knowledge of office practices, procedures, equipment, and desktop computer applications.
Intermediate knowledge of basic bookkeeping and accounting principles and practices.
Ability to explain and apply rules, regulations, and policies governing the processing of Workers' Compensation First Reports of Injury and Claims for Compensation.
Ability to calculate lost wages and distinguish the differences in benefits and payment levels owed for temporary partial disability, temporary total disability, permanent partial disability, and permanent total disability.
Ability to obtain and document relevant claim information clearly and concisely, evaluate information, and make determinations based on established policy and procedures.
Ability to work with electronically submitted data on a variety of databases.
Ability to compile relevant case information independently.
Ability to exercise sound judgment in the analysis of case information in order to expedite legal compliance issues and reduce delay in case adjudication.
Ability to perform mathematical calculations with speed and accuracy.
Ability to work rapidly and accurately in processing a large volume of documents.
Ability to communicate effectively and prepare clear and concise reports.
Ability to establish and maintain effective working relationships with other employees, employers, attorneys, insurance companies, third party administrators, health care providers, judges, and insured workers.
The following link will provide you with general information about State of Missouri employee benefits.View benefits