Job Description

This position coordinates timely workers comp payments for employees and healthcare providers. Uses RiskAlert/Pyramid software as the Risk Management database for liability and workers compensation. Must understand and professionally represent the liability and works comp programs. Independently prepares reports for State agencies (Mass. Board of Registration in Medicine and the Department of Industrial Accidents) to meet regulatory compliance, data validation reports for claims meetings, monthly litigation reports to senior management, Safety Committee, etc. Prepares claims correspondence, arranges meetings for adjusters with attorneys, physicians and other professional staff; sets up claims files, assists in the discovery process and maintains all office and routine systems.

Under the general supervision of the Claims manager and the Executive Assistant, handles highly sensitive, confidential liability and workers compensation claim/suit information involving large dollar settlements. Interacts with attorneys, courts, state agencies, adjusters, physicians and other professional staff. Has overall responsibility for the timeliness of reports to State agencies, as well as the accuracy of the claims information used in all reports, correspondence, input and transaction sheets.

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PRINCIPAL DUTIES AND ESSENTIAL FUNCTIONS:

•  Under the supervision of the Claims Manager who directs case-specific activities and Executive Assistant who directs process and office-related activities, drafts, types and forwards correspondence to outside attorneys, paralegals, insurance companies, governmental agencies, patients, physicians and employees.
• Organizes and prioritizes tasks effectively.
• Work involves frequent telephone and written contact with patients, attorneys, insurances companies, governmental agencies and hospital staff. Prepares litigation agenda for senior management.
• Enters and maintains information in Risk Management database for liability and works compensation. Prepares loss runs, incident and trending reports, data validation reports for claims meetings as well as special reports, as required.
• Sets up liability and works compensation claim files, prepares initial paperwork, input and transaction sheets in a timely fashion. Coordinates Workers Compensation claim between the claimant and insurance company under the direction of the claims adjuster. Maintains office files.
• Prepares information and reports needed by state agencies, such as the Board of Registration in Medicine and the Department of Industrial Accidents.
• Schedules appointments and meetings, as needed.
• Maintains collaborative team relationships with peers and colleagues in order to effectively contribute to the working group’s achievement of goals, and to help foster a positive work environment.
• Performs other similar job related duties as required or directed.

Qualifications

JOB KNOWLEDGE AND SKILLS:

• Excellent math, communication and writing skills required.
• Familiarity with computers required.
• Familiarity with the healthcare/legal/WC setting preferred.
• Paralegal preferred.
• Ability to communicate effectively with hospital staff, patients, outside attorneys, insurance companies and governmental agencies.
• Must be able to maintain accuracy while working under pressure.
• Performs independently within department policies and practices. Refers specific complex problems to supervisor where clarification of departmental policies and procedures may be required.

EDUCATION:

• Bachelor’s degree preferred.

EXPERIENCE:

•  Three years progressively more responsible related experience.
• Data entry skills and PC experience required.
• Minimum two years previous or on-the-job experience in processing claims to become proficient.

 An equivalent combination of education and experience, which provides proficiency in the areas of responsibility listed above, may be substituted for the above education and experience requirements.

WORKING CONDITIONS/PHYSICAL DEMANDS:

• Normal office work environment.

Additional Information

All your information will be kept confidential according to EEO guidelines.

AMERICANS WITH DISABILITIES STATEMENT:

Must be able to perform all essential functions of this position with reasonable accommodation if disabled.

The above statements are intended to describe the general nature and level of work being performed. They are not intended to be construed, as an exhaustive list of all responsibilities, duties and skills required of personnel so classified. Tufts Medical Center reserves the right to modify position duties at any time, to reflect process improvements and business necessity.

COVID-19 POLICY:

Please note that effective October 1, 2021, as a condition of employment at Tufts Medical Center, all employees and new hires must have received their complete dose of the COVID-19 vaccine, unless they have been granted an exemption.