The Delaware Valley Trusts is a fast-growing organization that provides health, workers’ compensation and property and liability coverage to its public entity members. Our offices are conveniently located in Horsham, PA. The Delaware Valley Trusts are distinguished by generally providing broader coverage and exemplary claims and member service, including a wide range of value-added benefits, workshops, and training opportunities for employees of its members.
Opportunities
Workers’ Compensation Claims Representative
As a member of the Delaware Valley Workers' Compensation Trust Team, the Workers’ Compensation Claims Representative is responsible for managing and resolving workers’ compensation claims in compliance with Pennsylvania law, coordinating with stakeholders, and ensuring timely, accurate, and professional claims handling from investigation through closure.
This position is responsible for investigating, evaluating, and resolving assigned claims within authority or upon approval of the Claims Manager. The incumbent works on a daily basis with the Workers’ Compensation Trust membership to share information, resolve issues and adjust claims in a timely manner in accordance with the PA Workers’ Compensation Act, industry best practices, and Trust policies and procedures.
Responsibilities and Essential Functions of the Position:
Prompt and thorough investigation of all assigned claims;
Ability to apply PA Workers’ Compensation Act and current case law to complete compensability determination; issue appropriate state forms accepting or denying the claim;
Ensure claim files are properly documented and claims coding/data is accurate and complete;
Respond to voicemail, email and correspondence within 24 business hours of receipt;
Reserve claims for the expected probable outcome; prepare strategies and plan of action to resolve claims; and where appropriate, provide the Claims Manager with indemnity, medical and expense reserve recommendations, for approval;
Maintain active and current diaries on all open claims; review each claim periodically to identify further investigation or tasks necessary to move the claim to closure;
Manage the litigation process with defense counsel and provide counsel with a complete summary of the claim, along with direction for future handling;
Manage claims within industry best practice and Trust guidelines, policies and procedures;
Identify the need for settlement and discuss recommendations with Claims Supervisor;
Notify the Claims Manager of all new claim petitions, decisions, settlement demands, settlement evaluations from defense counsel, requests for lien waivers, and requests for settlement authority;
Work collaboratively with members and Nurse Case Manager to execute return to work strategies;
Participate in Risk Control annual survey meetings with public entity members to review pending claims and claim service;
Maintain a working knowledge of the PA Workers’ Compensation Act, the requirements and applicable case law;
Manage claim recoveries including but not limited to; subrogation, restitution, pension credits and social security offsets;
Report claims to the excess carrier, respond to requests for information or direction by the excess carrier in a timely and professional manner;
Exercise independent judgment and initiative and carry out job functions with or without direct supervision;
Work effectively under time constraints to meet deadlines and manage a number of different tasks concurrently;
Work accurately and with attention to detail;
Maintain privacy of confidential records, correspondence and/or files;
Communicate effectively in writing, orally and with others to understand and convey information in a manner consistent with job functions;
Establish and maintain effective working relationships with co-workers, Trust members, etc;
Carry out job functions without posing a health or safety threat to self or others;
Maintain acceptable attendance standards;
Perform other related duties and responsibilities as assigned.
Physical Demands of Job:
Ability to sit for extended periods of time while working;
Frequent hand, fingers and arm use and excellent eye-hand coordination;
Ability to see and perform visual activities such as close-up paperwork, using a display monitor, reading and writing;
Ability to lift and/or move up to 25 lbs.
Qualifications:
Bachelor’s degree from an accredited institution and two years of workers’ compensation claims experience or medical claims analysis or related field; or
Five to seven years of workers’ compensation claims experience or medical claims analysis or related field; or
Equivalent combination of education, experience and/or training which provides the knowledge, skills and abilities necessary to perform the essential functions of the position and required work;
Ability to review and comprehend insurance coverage documents and contracts;
Proficiency with Microsoft Word, Excel, PowerPoint, and Outlook;
Proficiency with Risk Management software (preferably Origami Risk);
Strong math, analytical and investigative skills;
Ability to interact with Trust employees, members, vendors, etc. in a professional, courteous and patient manner;
Strong organizational skills with ability to multitask and work independently;
Strong communication skills.
Compensation and Benefits:
The Delaware Valley Trusts offers a competitive salary commensurate with education and experience, along with many employer-paid benefits. Our comprehensive benefits package includes life insurance, health insurance, dental insurance, vision insurance, flexible spending accounts, defined benefit retirement plan, deferred compensation plan, generous paid time off, short and long-term disability coverage, tuition assistance, and other training and professional development opportunities. Our office dress code is business casual.
Equal Opportunity Employer:
The Delaware Valley Trusts are committed to equal employment opportunity and compliance with all laws and regulations pertaining to it. Our policy is to provide employment, training, compensation, promotion, and other conditions or opportunities of employment, without regard to race, color, religion, age, sex, sexual orientation, transgender, national origin, disability, genetic information, veteran or marital status, or any other characteristic protected by law.
Job Type: Full-time
Pay: $60,000.00 – $68,000.00 per year
Schedule: Monday to Friday
Work Location: Hybrid remote in Horsham, PA 19044
How to Apply: If you are interested in exploring this career opportunity, please submit a resume, cover letter, and salary requirements to careers@dvtrusts.com.
Health Claims Specialist
As a member of the Delaware Valley Health Trust Team, the Health Claims Specialist facilitates accurate responses to member and enrollee inquiries regarding benefits, claims, billing, eligibility, coverage and other related information via phone and email.
The Delaware Valley Trusts is a fast-growing organization that provides health, workers’ compensation and property and liability coverage to its public entity members. Our offices are conveniently located in Horsham, PA. The Trusts are distinguished by generally providing broader coverage and exemplary claims and member service, including a wide range of value-added benefits, workshops, and training opportunities for employees of its members.
Responsibilities and Essential Functions of the Position:
Research and resolve coding, billing and payment-related issues with respect to medical, prescription drug, dental and vision claims, including but not limited to office visits, inpatient and outpatient procedures, diagnostic imaging, medical equipment and preventive care;
Explain cost-sharing concepts related to medical, prescription drug, dental and vision coverage co-pays, deductibles, etc. including but not limited to office visits, inpatient and outpatient procedures, diagnostic imaging, medical equipment and preventive care;
Identify and resolve coordination of benefits issues with Medicare and insurance companies;
Identify and communicate in-network primary care or specialist physicians in a geographic area or particular specialty;
Return phone calls and respond to emails in a prompt manner to ensure high-quality member service;
Track member inquiries and resolutions in accordance with established protocol;
Exercise independent judgment and initiative and carry out job functions with or without direct supervision;
Work effectively under time constraints to meet deadlines and manage a number of different tasks concurrently;
Work accurately and with attention to detail;
Maintain privacy of confidential records, correspondence and/or files;
Communicate effectively in writing, orally and with others to understand and convey information in a manner consistent with job functions;
Establish and maintain effective working relationships with co-workers, Trust members, etc;
Carry out job functions without posing a health or safety threat to self or others;
Maintain acceptable attendance standards;
Perform other related duties and responsibilities as assigned.
Physical Demands of Job:
Ability to sit for extended periods of time while working;
Frequent hand, fingers and arm use and excellent eye-hand coordination;
Ability to see and perform visual activities such as close-up paperwork, using a display monitor, reading and writing;
Ability to lift and/or move up to 25 lbs.
Qualifications:
High school diploma or GED and three years of customer service experience analyzing and solving customer health claim issues; or
Associate degree in health field with one year of customer service experience analyzing and solving customer health claim issues; or
Equivalent combination of education, experience and/or training which provides the knowledge, skills and abilities necessary to perform the essential functions of the position and required work;
Previous claims experience with a health insurance issuer or third-party administrator is highly desired. Call center experience is a plus;
Ability to read and comprehend insurance coverage documents including summary plan descriptions and summaries of benefits as well as clinical policy bulletins;
Strong working knowledge of medical coding and billing;
Proficiency with Microsoft Word, Excel, PowerPoint, and Outlook;
Knowledge of principles and processes for providing high-quality customer service;
Ability to interact with Trust employees, members, vendors, etc. in a professional, courteous and patient manner;
Strong organizational skills with ability to multitask and work independently;
Strong communication skills.
Compensation and Benefits:
The Delaware Valley Trusts offers a competitive salary commensurate with education and experience, along with many employer-paid benefits. Our comprehensive benefits package includes life insurance, health insurance, dental insurance, vision insurance, flexible spending accounts, defined benefit retirement plan, deferred compensation plan, generous paid time off, short and long-term disability coverage, tuition assistance, and other training and professional development opportunities. Our office dress code is business casual.
Equal Opportunity Employer:
The Delaware Valley Trusts are committed to equal employment opportunity and compliance with all laws and regulations pertaining to it. Our policy is to provide employment, training, compensation, promotion, and other conditions or opportunities of employment, without regard to race, color, religion, age, sex, sexual orientation, transgender, national origin, disability, genetic information, veteran or marital status, or any other characteristic protected by law.
Job Type: Full-time
Pay: $55,000.00 – $58,000.00 per year
Schedule: Monday to Friday
Work Location: Hybrid remote in Horsham, PA 19044
How to Apply: If you are interested in exploring this career opportunity, please submit a resume, cover letter, and salary requirements to careers@dvtrusts.com.
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