Claims Resolution Specialist

at State of Maine, Bureau of Human Resources in Portland, Maine, United States

Job Description

Claims Resolution Specialist

Portland , Maine , United States | Workers’ Compensation | Full-time Apply by: Sept. 29, 2023 Apply with Linkedin Apply Workers’ Compensation Board Claims Resolution Specialist – Portland Advocate Office Anticipated Vacancy Code: 0370 Pay Grade:22 – $43,201.60 – $57,969.60/Annually Open for Recruitment: September 15, 2023 Closed to Recruitment: September 29, 2023 Purpose Of Announcement: The Workers Compensation Board has a full-time vacancy in Portland, Maine. Description: This is administrative work that provides assistance and technical expertise to employees, employers, and their representatives in processing and settling benefit/compensation claims. Responsibilities include initial screening of benefit/compensation claims; gathering and examining information from concerned parties, insurance carriers, and health care providers; and determining the nature of the controversy as well as applicable state laws and regulations. An important role of these positions is to independently facilitate a resolution of disputed claims at the earliest possible juncture and thereby eliminate the necessity of mediation. Work is performed under limited supervision. Representative Tasks :

+ Reviews files and interviews parties in disputed benefit/compensation claims in order to determine exact nature of controversy.

+ Gathers and analyzes medical information related to claims in order to identify nature and extent of claims.

+ Evaluates and examines intake information in order to prepare and research claims.

+ Meets and confers with employees, employers, and/or their representatives in order to determine scope of claim and whether additional information is needed.

+ Advises all parties as to status of pending cases and of applicable laws, rules, regulations, and procedures in order to facilitate resolution, understanding, and compliance.

+ Compiles statistical information concerning resolved/unresolved cases in order to provide information to administrators.

+ Responds to requests for information in order to provide information.

+ Schedules unresolved claims cases for mediation.

Knowledges, Skills, and Abilities Required: (These are required to successfully perform the work assigned).

+ Knowledge of applicable state laws, rules, regulations, practices, and procedures.

+ Knowledge of paralegal and medical terminology.

+ Knowledge of interviewing techniques.

+ Ability to interview, explain and gather information.

+ Ability to maintain complex case records.

+ Ability to analyze claims and clarify issues.

+ Ability to present and defend one’s position orally and in writing.

+ Ability to communicate effectively orally and in writing.

Minimum Qualifications: A Bachelors’ Degree in a related field and at least two (2) years of technical or para-professional work experience in resolving benefit/compensation claims, conflict and/or dispute resolution, or mediation, or 4 years of directly related Workers’ Compensation experience. Benefits: No matter where you work across Maine state government, you find employees who embody our state motto-“Dirigo” or “I lead”-as they provide essential services to Mainers every day. We believe in supporting our workforce’s health and wellbeing with a valuable total compensation package, including:

+ Work-Life Balance – Rest is essential. Take time for yourself using 13 paid holidays, 12 days of sick leave, and 3+ weeks of vacation leave annually. Vacation leave accrual increases with years of service, and overtime-exempt employees receive personal leave.

+ Health Insurance Coverage – The State of Maine pays 85%-100% of employee-only premiums ($10,150.80-$11,942.16 annual value), depending on salary. Use this chart to find the premium costs for you and your family, including the percentage of dependent coverage paid by the State.

+ Health Insurance Premium Credit – Participation decreases employee-only premiums by 5%. Visit the Office of Employee Health and Wellness for more information about program requirements .

+ Dental Insurance – The State of Maine pays 100% of employee-only dental premiums ($350.40 annual value).

+ Retirement Plan – The State of Maine contributes 13.16% of pay to the Maine Public Employees Retirement System (MainePERS), on behalf of the employee.

+ Gym Membership Reimbursement – Improve overall health with regular exercise and receive up to $40 per month to offset this expense.

+ Health and Dependent Care Flexible Spending Accounts – Set aside money pre-tax to help pay for out-of-pocket health care expenses and/or daycare expenses.

+ Public Service Student Loan Forgiveness – The State of Maine is a qualified employer for this federal program. For more information, visit the Federal Student Aid office .

+ Living Resources Program – Navigate challenging work and life situations with our employee assistance program.

+ Parental leave is one of the most important benefits for any working parent. All employees who are welcoming a child-including fathers and adoptive parents-receive four weeks of fully paid parental leave. Additional, unpaid leave may also be available, under the Family and Medical Leave Act ( .

+ Voluntary Deferred Compensation – Save additional pre-tax funds for retirement in a MaineSaves 457(b) account through payroll deductions.

+ Learn about additional wellness benefits for State employees from the Office of Employee Health and Wellness ( .

There’s a job and then there’s purposeful, transformative work. Our aim is to create a workplace where you can learn, grow, and continuously refine your skills. Applicants demonstrate job requirements in differing ways, and we appreciate that many skills and backgrounds can make people successful in this role. As an Equal Opportunity employer, Maine State Government embraces a culture of respect and awareness. We are committed to creating a strong sense of belonging for all team members, and our process ensures an inclusive environment to applicants of all backgrounds including diverse race, color, sex, sexual orientation or gender identity, physical or mental disability, religion, age, ancestry, national origin, familial status or genetics. If you’re looking for a great next step, and want to feel good about what you do, we’d love to hear from you. Please note reasonable accommodations are provided to qualified individuals with disabilities upon request. Thinking about applying? Research shows that people from historically excluded communities tend to apply to jobs only when they check every box in the posting. If you’re currently reading this and hesitating to apply for that reason, we encourage you to go for it! Let us know how your lived experience and passion set you apart.
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Job Posting: JC248011210

Posted On: Sep 17, 2023

Updated On: Oct 02, 2023

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