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Claims Specialist 2025-02400

Claims Specialist 2025-02400

Government JobsCheyenne, WY, US
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Claims Specialist

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 : kelly.gayer@wyo.gov

Essential Functions :

  • 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.

    • Qualifications

    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 3-4 years of progressive work experience (typically in Benefits and Eligibility)

    Certificates, Licenses, Registrations : None

    Necessary Special Requirements

    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 at https : / / www.uscis.gov / e-verify
  • 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.

    • Working for the State of Wyoming provides employees with a range of valuable benefits and offers a fulfilling career path. Employees enjoy comprehensive healthcare coverage, including medical, dental, and vision plans, ensuring their well-being and that of their families. Additionally, the state offers multiple retirement plans, which provide financial security and stability for employees once their career in public services comes to an end. The state recognizes the importance of personal time and offers generous paid time off and flexible arrangements, allowing employees to recharge, take care of personal matters, and maintain a healthy work-life integration. There are many benefits to living and working in Wyoming. Beautiful country with wide-open spaces, clean air, great recreational activities, and no State income tax to mention a few!

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    Claim Specialist • Cheyenne, WY, US

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