Technical Operator III

Job Description:

• Evaluate, negotiate, and settle workers’ compensation claims in compliance with applicable laws and internal policies
• Review and analyze medical bills, treatment records, and claim documentation to determine appropriate settlement values
• Negotiate with medical providers and other parties to reach fair and timely resolutions
• Ensure compliance with applicable state workers’ compensation laws and regulations
• Maintain accurate and up-to-date documentation of negotiations and outcomes in the claims management system
• Identify cost-saving opportunities and minimize claim exposure
• Communicate clearly and professionally with internal and external contacts
• Monitor claims for trends and report potential areas of concern
• Work closely with providers, adjusters, and internal teams

Requirements:

• 2–5 years of experience in workers’ compensation claims handling, bill review, or negotiation (or equivalent combination of education and experience)
• Strong knowledge of workers’ compensation regulations and fee schedules
• Strong understanding of medical billing codes (CPT, ICD-10, HCPCS), state fee schedules, and PPO discounts
• Excellent written and verbal communication and negotiation skills
• Strong attention to detail and ability to manage multiple cases independently
• Excellent analytical skills
• Ability to work independently and manage multiple priorities in a fast-paced environment
• Proficiency with claims management systems and Microsoft Office Suite
• Experience in a TPA, insurance carrier, or medical cost containment company preferred