Senior Claims Specialist

USA: | Records Management | Full Time

21.00 - 21.00 USD per hour

The mission of the Idaho Industrial Commission is to fairly administer the Idaho Workers' Compensation Law.

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Summary:

Are you someone who enjoys digging into data, identifying discrepancies, and ensuring workers’ compensation claims are processed accurately? The Senior Claims Specialist (TRS2) plays a key role in maintaining the accuracy of workers’ compensation claims and benefits. This position combines analytical review, problem-solving, and subject matter expertise in Electronic Data Interchange (EDI) reporting.

• Gather information, issue correspondence, and make decisions
• Utilize independent judgment and discretion when completing assignments
• Audit complex benefit calculations of Subsequent Reports of Injury (SROI) and Final Report transactions
• Examine insurer claim files to evaluate performance
• Resolve higher level claims issues
• Use analytical software to provide data to EDI trading partners
• Communicate EDI transaction requirements to trading partners

Typically met by at least one year in each of the following areas.

• Monitoring record systems to identify and correct errors
• Interpreting, explaining, and applying laws, regulations, and complex policies to carry out assignments
• Analyzing information and researching a variety of sources to identify and resolve problems or issues
• Entering and retrieving data using a computerized record system
• Composing and proofreading business correspondence
• Compiling information in a report format using database software

• Experience using word processing and spreadsheet software at an intermediate skill level
• Certified Idaho Workers' Compensation Specialist (CIWCS):
  Certified as an Idaho Workers' Compensation Specialist or willing to certify within six (6) months of hire
• Reviewing technical materials and making determinations

• Participation in one of the Nation's best state retirement systems (PERSI)
• Eligible for Public Service Loan Forgiveness (PSLF)
• 11 paid holidays a year
• Paid parental leave for new parents
• Generous sick and vacation leave that begins accruing on your first day
• Optional 401(k) and 457 retirement savings plans
• Basic life insurance for you and your family
• Wellness programs and resources available 24/7

The State of Idaho is committed to providing equal employment opportunities and prohibits discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibits discrimination against all individuals based on their race, color, religion, political affiliation or belief, sex, national origin, genetics, or any other status protected under applicable federal, state, or local laws.

The State of Idaho is committed to access and reasonable accommodation for individuals with disabilities, auxiliary aids and services are available upon request. If you require an accommodation at any step in our recruitment process, you are encouraged to contact  (TTY/TTD:711), or email ada.coordinator ho.gov.

Preference may be given to veterans who qualify under state and federal laws and regulations.