Claims Specialist 2025-00640

Open Until Filled GENERAL DESCRIPTION: The Wyoming Department of Workforce Services is seeking a Claims Specialist to perform case management functions of Workers' Compensation for assigned employer accounts, determine the compensability of cases, and monitor for fraud and improprieties. In addition to compensation, employment at the Department of Workforce Services provides the following: • Culture of public service and a commitment to work/life balance • Eligibility for Public Service Student Loan Forgiveness • Health, Dental, and Vision Insurance • State Retirement plan and additional savings opportunities • Paid vacation, sick leave, and holidays • For additional information regarding the benefits package please visit https://ai.wyo.gov/for-job-seekers/benefit-information Human Resource Contact: [email protected] ESSENTIAL FUNCTIONS: The listed functions are illustrative only and are not intended to describe every function that may be performed at the job level. • Use case management skills to guide customers through the Workers' Compensation benefits program. • Review injury reports. • Investigate the circumstances of the injury. • Make eligibility determinations on the claim for benefits by reviewing applications and medical reports. • Process claims for indemnity benefits. • Communicate clearly the rights, responsibilities, and benefits of the Workers' Compensation program. • Assist injured workers with filing requirements and understanding the complex claims processes. • Refer appropriate cases for hearing and may provide testimony in the hearings. • Respond directly to employers or vendors in regard to questions on procedures or the status of cases or claims. • Coordinate return to work and work restrictions with healthcare providers and employers. • Analyze medical documentation to determine the compensability of claims. • Initiate and monitor program requirements and process benefits. • Mediate disputes involving injured workers, employers, healthcare providers, and the division. • Coordinate with healthcare providers to effectively manage the compensable injury and establish appropriate diagnoses and treatment plans for the injury. PREFERENCES: Preference may be given to those with Claims Management and/or Claims Service experience. Preference may be given to those with Customer Service experience. Preference may be given to those with a Bachelor's degree in Management and/or Social Services. KNOWLEDGE: • Knowledge of Workers' Compensation Law and Rules & Regulations. • Ability to assist clients in working through complex processes. • Ability to work independently. • Ability to analyze situations and provide resolutions within the statutes. • Knowledge of medical terminology • Knowledge of case management • Knowledge of customer service MINIMUM QUALIFICATIONS: Education: Bachelor's Degree Experience: 0-1 year of progressive work experience (typically in Benefits and Eligibility) OR Education & Experience Substitution: 3-4 years of progressive work experience (typically in Benefits and Eligibility) Certificates, Licenses, Registrations: None NOTES: • FLSA: Non-Exempt • Former State of Wyoming employees who are rehired less than 31 days after their final day in their old agency, must repay all leave payouts. • The Wyoming Department of Workforce Services (DWS) uses E-Verify, an Internet-based system, to confirm the eligibility of all newly hired employees to work in the United States. Learn more about E-Verify, including your rights and responsibilities. • For the Veteran's preference consideration, supporting documentation must accompany your application. • Offers of employment will be contingent upon the successful completion of a background check. Click here to view the State of Wyoming Classification and Pay Structure. URL: http://agency.governmentjobs.com/wyoming/default.cfm The State of Wyoming is an Equal Opportunity Employer and actively supports the ADA and reasonably accommodates qualified applicants with disabilities. Class Specifications are subject to change, please refer to the A & I HRD Website to ensure that you have the most recent version. Apply Job!