Workers’ Compensation Insurance Verification Specialist

JOB SUMMARY

The Workers’ Compensation Insurance Verification Specialist is responsible for verifying and documenting workers’ compensation insurance coverage for patients receiving care at our clinics. This role ensures accurate billing, proper claim handling, and compliance with Texas workers’ compensation regulations by confirming coverage details prior to patient visits.

RESPONSIBILITIES

• Verify workers’ compensation insurance coverage for injured workers prior to appointments and services.
• Collect and confirm claim details, including employer information, insurance carrier, claim number, and adjuster contact information.
• Communicate with employers, insurance carriers, and third-party administrators (TPAs) to validate active coverage and authorization requirements.
• Ensure all workers’ compensation documentation is complete and accurate before patient treatment or billing.
• Enter and update insurance and claim information in the clinic’s electronic health record (EHR) and billing systems.
• Identify and resolve discrepancies in coverage, eligibility, or claim details.
• Coordinate with front desk staff, medical providers, and billing departments to ensure proper handling of workers’ compensation cases.
• Assist with obtaining treatment authorizations when required.
• Maintain compliance with Texas workers’ compensation guidelines and clinic policies.
• Protect patient confidentiality in accordance with HIPAA regulations.

EDUCATION

• High school diploma or equivalent required; additional healthcare or insurance-related education preferred.
• 1–3 years of experience in medical insurance verification, preferably in workers’ compensation or a healthcare setting.
• Familiarity with Texas workers’ compensation processes and billing practices.
• Experience with EHR systems and medical billing software.
• Strong attention to detail and ability to manage multiple cases simultaneously.
• Excellent communication and customer service skills.

KNOWLEDGE SKILLS & ABILITIES

• Knowledge of workers’ compensation claim workflows in a clinical environment.
• Experience verifying benefits for occupational health or injury-related visits.
• Ability to interpret insurance information and explain coverage to patients and staff.
• Strong organizational and problem-solving skills.

Benefits:

• 401(k)
• Dental insurance
• Disability insurance
• Flexible spending account
• Health insurance
• Health savings account
• Life insurance
• Paid time off
• Retirement plan
• Vision insurance

Work Location: In person