Workers Compensation Medical Provider Appeals Analyst

Job Description

Who Are We?

Taking care of our customers, our communities and each other. That’s the Travelers Promise. By honoring this commitment, we have maintained our reputation as one of the best property casualty insurers in the industry for over 160 years. Join us to discover a culture that is rooted in innovation and thrives on collaboration. Imagine loving what you do and where you do it.

Compensation Overview

The annual base salary range provided for this position is a nationwide market range and represents a broad range of salaries for this role across the country. The actual salary for this position will be determined by a number of factors, including the scope, complexity and location of the role; the skills, education, training, credentials and experience of the candidate; and other conditions of employment. As part of our comprehensive compensation and benefits program, employees are also eligible for performance-based cash incentive awards.

Salary Range

$44,700.00 - $73,800.00

Target Openings

1

What Is the Opportunity?

Under general supervision this position is responsible for examining and evaluating previously paid moderate to complex medical bills, based on additional information submitted by medical providers, to determine and generate correct payment. Responding to escalated calls from medical providers regarding payment decisions for medical services. Responsible for keeping abreast of rules, regulations and contracts that are continuously changing.
Travelers offers a hybrid work location model that is designed to support flexibility. 3 days in office/2 days remote.
#LI-Hybrid

What Will You Do?

• Perform a detailed review of previously submitted medical, hospital, durable medical equipment, pharmacy, home health et al bills along with accompanying reports/information for accuracy and to determine appropriateness.
• Using multiple screens on the Medical Bill Re-pricing System, read and interpret scanned medical reports to determine that services on bill were actually performed and coded to reflect the services that were actually provided.
• Compare bill and rates with appropriate fee schedules, clinical edits, Medicare, National Correct Coding Initiative (NCCI), internal Travelers protocols and PPO contracts to determine whether additional payment is due or if recovery of overpayment is necessary.
• Compile all medical bills to determine if there is overlap or duplication of any services.
• Apply payment policies to medical supplies and drugs/ medicine.
• Make accurate payments to medical providers based on the results and analysis of each medical bill.
• If original decision will be upheld, develop a formal response with supporting documentation. Commence recovery measures, when overpayment has occurred.
• Serve as the liaison between the provider and company including department leadership, Travelers Claim Product team and third party vendors.
• Regularly and independently identify and bring to managements attention any unusual/new medical procedures or billing anomalies identified during the review.
• In addition to day-to-day responsibilities, participates on high volume special projects in support of the New Product team.
• Deliver superior customer service to Travelers Claim professionals and those medical providers with escalated issues. Answer questions and analyze and resolve problems.
• Perform other duties as assigned.

What Will Our Ideal Candidate Have?

• College degree preferred and /or equivalent work experience.
• Previous Appeals experience reviewing workers compensation medical bills highly desirable.
• Solid customer service telephone skills.
• Strong interpersonal communication skills.
• Strong verbal and written communication skills, including effective sentence construction, grammar, spelling, and punctuation. Basic computer skills: ability to toggle between multiple screens to find data that is needed to process medical bills.
• Proficiency in Microsoft Office products (e.g. Excel, PowerPoint, Word, Outlook).
• Good working knowledge of human anatomy and medical terminology preferred
• .
• Working knowledge of Workers Compensation processes and procedures including fee schedule and payment rules preferred.
• Solid math skills: must be able to quickly and accurately add, subtract, multiply and divide with the assistance of a calculator.
• Proven ability and interest in staying abreast of new and emerging medical trends and literature.
• Strong attention to detail and ability to independently read and comprehend completely the details of a medical bill/report and notes and assess them against all appropriate rules and protocols.
• Strong comprehension and analytical skills
• Ability to produce high quality results in a high production environment
• Superior Organizational Skills and Attention to Detail
• Commitment to Task
• Continuous Learning
• Decision Making and Problem Solving skills.
• Decisiveness
• Sense of urgency
• Flexibility
• Certified Coder preferred or commensurate experience with the following resource materials:
• Current Procedural Terminology (CPT)
• International Classification of Diseases-9 (ICD-9) Revision
• Healthcare Common Procedural Coding System - 9th Revision (HCPCS) codes
• Itemized hospital bills, hospital records.
• Certified California Medical Bill Reviewer a plus.

What is a Must Have?

• High School Diploma or GED.

What Is in It for You?

• Health Insurance: Employees and their eligible family members – including spouses, domestic partners, and children – are eligible for coverage from the first day of employment.
• Retirement: Travelers matches your 401(k) contributions dollar-for-dollar up to your first 5% of eligible pay, subject to an annual maximum. If you have student loan debt, you can enroll in the Paying it Forward Savings Program. When you make a payment toward your student loan, Travelers will make an annual contribution into your 401(k) account. You are also eligible for a Pension Plan that is 100% funded by Travelers.
• Paid Time Off: Start your career at Travelers with a minimum of 20 days Paid Time Off annually, plus nine paid company Holidays.
• Wellness Program: The Travelers wellness program is comprised of tools and resources that empower you to achieve your wellness goals. In addition, our Life Balance program provides access to professional counseling services, life coaching and other resources to support your daily life needs. Through Life Balance, you’re eligible for five free counseling sessions with a licensed therapist.
• Volunteer Encouragement: We have a deep commitment to the communities we serve and encourage our employees to get involved. Travelers has a Matching Gift and Volunteer Rewards program that enables you to give back to the charity of your choice.

Employment Practices

Travelers is an equal opportunity employer. We value the unique abilities and talents each individual brings to our organization and recognize that we benefit in numerous ways from our differences.

If you are a candidate and have specific questions regarding the physical requirements of this role, please send us an email so we may assist you.

Travelers reserves the right to fill this position at a level above or below the level included in this posting.

To learn more about our comprehensive benefit programs please visit http://careers.travelers.com/life-at-travelers/benefits/.