Handles complex Workers’ Compensation claims, including coverage investigation, compensability decisions, reserves, payments, subrogation, litigation, recoveries, settlement negotiations, and regulatory filings. Coordinates with case managers, attorneys, customers, claimants, and carriers to reduce claim costs and support return-to-work efforts. Maintains compliance with state requirements, manages claim documentation, communicates claim status, and supports team knowledge development.

Supervise hospital bill audit nurses, ensuring accurate audits and compliance with regulations. Foster team collaboration and handle auditor inquiries while maintaining productivity standards.

The Appeals Representative analyzes appeals in accordance with policies and guidelines, communicates with providers, and ensures timely completion of appeals while adhering to industry standards.