SUMMARY: The primary responsibility of this role is to create, maintain, and build a repository of provider panels adhering to state specific regulations. This position will submit panels to agents, insured's, and internal customers. Daily contacts include internal staff at all levels, and external customers such as agents, insured and physician offices.. PRIMARY RESPONSIBILITIES: * Track production statistics. Develops and maintains , databases and filing systems used for storing of panels and postings. * Provide first line contact with physician offices to validate specialty, demographic information, and acceptance on injured workers at all participating locations. * Responds to inquiries from agents, insureds and brands, includes answering general questions, accommodating special request and sending completed panels * Create provider panels using our Care Analytics tool or other available resources. * Responsible for research using Google, MapQuest and other search engines available on the internet. * Update provider list for non panel states. * Keep up to date with rule changes that impact provider panels in all states. * Select appropriate physicians by specialty as required by the state regulations. * Ensure accuracy and completeness of provider panels. * Meet established timelines for completion of panel request. * Provide or assist training sessions for team and other business units as necessary. * Log provider panel requests and monitor timely delivery of panels. * Research and supplement panels with new providers in areas where there is little to no coverage of preferred providers. * Monitor provider panel age and update provider panels with new information when expired or within 3 to 6 months from last verification date. * Work with corporate medical director to assist with certification of MPNs or other network systems required by the state. * Participate in Medical Review Board to stay current on providers that are not treating to company standards. * Mitigate risks of fines for inaccurate or missing panel postings. * Facilitate sharing of panels between brands to minimize redundancy and to consolidate efforts for the enterprise. * Ensure compliance with statutory changes as they relate to provider panels. * Maintain confidentiality. * Verify that licensure and NPI is current for all care analytic physicians being evaluated for use on our panels or postings. * Responsible for completing special projects as requested by agents, insured and brands. This includes the need for multi-lingual posting or panels. * Receives returned pharmacy cards and completes necessary follow-up to get the pharmacy card sent out to the injured worker at their correct address. EMPLOYMENT QUALIFICATIONS: A. EDUCATION REQUIRED: High school diploma or G.E.D required with additional training or college-level course work in workers' compensation or insurance. B. EXPERIENCE REQUIRED: Minimum three years workers compensation experience, including two years of demonstrated technical knowledge in a claims or medical environment (i.e. applying relevant workers compensation laws, regulations, guidelines, and/or policies) required. One year customer service experience exchanging information and answering and resolving inquiries over the phone required. C. SKILLS/KNOWLEDGE/ABILITIES (SKA) REQUIRED: * Knowledge of medical provider specialties. * Knowledge of medical terminology and legal terminology. * Ability to read, analyze and interpret contracts and governmental regulations. * Ability to establish work flows, manage multiple projects and meet necessary deadlines while maintaining composure during stressful situations occurring as a result of workloads and/or deadlines. * Ability to research information in multiple systems including various mappings sites. * Ability to solve problems. * Ability to work independently in a multi-functional business unit. * Excellent customer service skills * Excellent telephone etiquette * Knowledge of computers, word processing and spreadsheet software with ability to enter accurately at 50 WPM. * Ability to proofread documents for accuracy of spelling, grammar, punctuation, and format. * Excellent organizational skills and ability to prioritize work. * Excellent oral and written communication skills with a high degree of quality and accuracy. * Knowledge of workers compensation industry * Ability to establish a rapport and maintain an effective working relationship with both internal and external customers. * Understanding of enterprise, company, and departmental operations. * Ability to make competent, independent decisions. * Ability to take initiative/ownership of the process of creating provider panels. D. ADDITIONAL EDUCATION, EXPERIENCE, SKILLS, KNOWLEDGE, AND/OR ABILITIES PREFERRED: * Knowledge of multi-state claims processing. * Experience handling claims in multiple states. * Industry designation. WORKING CONDITIONS: Work is performed in an office setting with no unusual hazards. REQUIRED TESTING: Intermediate Excel, Intermediate Word, Intermediate Windows, Reading Comprehension, 50 wpm and Proofreading
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