Workers%27 Compensation Specialist

The Human Resources Division (HRD) is an agency within the Executive Office for Administration and Finance.
HRD provides support to state agencies in all matters relating to the Commonwealth's classification, compensation, benefits, recruitment, training & employee development, civil rights, collective bargaining and workers' compensation administration.
The mission of the Human Resources Division (HRD) is to attract, develop and retain a high performing workforce in order to ensure the delivery of constituent services across the Commonwealth.
About the Workers' Compensation Unit
The Human Resources Division/Workers' Compensation Unit (HRD/WC) is the legislatively authorized administrator of the Commonwealth's self-insured workers' compensation program.
HRD/WC uses a medical management strategy to facilitate the employee's recovery and return to work.
It is the goal of HRD/WC to return injured employees to gainful employment in a timely, efficient way.
Position Summary
Under the leadership of the Director of Workers' Compensation, the Workers' Compensation Specialist is responsible for overseeing specialty programs that fall within the Workers' Compensation claim program.
Duties and Responsibilities :

The position requires a strong working knowledge of Mass WC Law Chapter 152, with emphasis on Section 15 for recovery of funds paid due to liability of a third party.
In addition, candidates should be knowledgeable of CPT/ICD medical coding and the WC Fee Schedule.
Additional duties include:

Third Party Subrogation
Work with HRD/WC adjusters, partner agencies, plaintiff and defense counsel to identify, investigate and pursue recovery from a liable third party for work-related injuries.
Work with defense counsel and partner agencies during the resolution and settlement process, to ensure appropriate documentation is completed, and funds are recovered and credited to the claim.
Analyze, study and report trends of third-party claims activity to ensure the best cost savings to our partner agencies.
Maintain and adhere to diary system to ensure notice of liens are issued and deadlines are met.
Report out on findings as needed.
Medicare Claims Reporting and Claim Handling
Work with A&F IT to ensure quarterly reporting to Medicare is done timely with limited errors.
Communicate errors to the WC Unit and assist in case specific reviews as needed.
Participate in ongoing training and Webex sessions for updated topics in this field.
Ensure receipt, review and acknowledgment of claims made by Medicare to HRD/WC.
Serve as liaison to the Comptroller's Office when an intercepted payment has been made.
Provide training to adjusters as needed.
Medical Fee Negotiations
Review surgical and related requests for fees outside of Board rates, making comparisons to Medicare rates or board rates as indicated.
Track all negotiations for reference in future requests.
Other Duties as Assigned
Handle small caseload of WC claims.
Provide coverage for adjusters who may be absent on an as needed basis.
Special projects on an ad hoc basis.
Supervision of WC employees.
Preferred Qualifications
Applicants should have at least four years of full-time or equivalent part-time, professional experience in workers' compensation, and some casualty claims experience is preferred.
Knowledge of Medicare Section 111 Reporting requirements is helpful.
Minimum Entrance Requirements:

Applicants must have at least (A) four (4) years of full-time or, equivalent part-time, professional, professional internship, administrative, supervisory, or managerial experience in business administration, business management, public administration, public management, clinical administration or clinical management or (B) any equivalent combination of the required experience and substitutions below.
Substitutions:

A certificate in a relevant or related field may be substituted for one (1) year of the required experience.
An Associate's degree in a related field may be substituted for one (1) year of the required experience.
A Bachelor's degree in a related field may be substituted for two (2) years of the required experience.
A Graduate degree in a related field may be substituted for three (3) years of the required experience.
A Doctorate degree in a related field may be substituted for the required experience.
Comprehensive Benefits
When you embark on a career with the Commonwealth, you are offered an outstanding suite of employee benefits that add to the overall value of your compensation package.
We take pride in providing a work experience that supports you, your loved ones, and your future.
Want the specifics? Explore our Employee Benefits and Rewards!
An Equal Opportunity / Affirmative Action Employer.
Females, minorities, veterans, and persons with disabilities are strongly encouraged to apply.
The Commonwealth is an Equal Opportunity Employer and does not discriminate on the basis of race, religion, color, sex, gender identity or expression, sexual orientation, age, disability, national origin, veteran status, or any other basis covered by appropriate law.
Research suggests that qualified women, Black, Indigenous, and Persons of Color (BIPOC) may self-select out of opportunities if they don't meet 100% of the job requirements.
We encourage individuals who believe they have the skills necessary to thrive to apply for this role.
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