Position Overview 

The Claimant Outreach Coordinator will be responsible for administrative and customer relations support as it relates to processing claims and will play an active role in all phases of the claims processing.  The Claimant Outreach Coordinator will guide individuals or families who experience various social, financial, health, or personal issues.  The position will maintain an ongoing and progressive relationship with families and support workers. They will communicate and liaise with other professionals, including therapists, social services, medical practitioners, benefits agencies and others.  The position maintains good rapport and communications while partnering with the Program’s team members. The position will report to the Claims Manager and is Exempt under the Fair Labor Standards Act (FLSA). 

Duties and Responsibilities: 

• Provide a meaningful “core” service for each claimant admitted into the Program to ensure all care plan goals and claims are addressed in compliance with the Act, the Guidelines, and applicable laws and regulations. 

• Funnel all reimbursement requests or payment requests to the Program staff person assigned to process each type of claim or request.  Facilitate the claims administration process by coordinating efforts with all Program staff. 

• Gather detailed documentation for review and verification. 

• Confirms coverage of claims by reviewing policies and documents submitted in support of claims.  Analyzes coverage and communicates coverage decisions. 

• Establish objectives and a clear claims management plan for Program claimants in consultation with the client and others involved. 

• Monitor progress and changes in the Program claimant's situation and revise claim statuses accordingly. Track all claims submissions to ensure timely responses to admitted claimants’ parents/guardians and vendors by Program staff. 

• Establish a good working relationship with the admitted claimant and his/her family. 

• Maintain accurate documentation of claims in accordance with the Program Guidelines and the governing statutes and regulations. 

• Communicate with admitted claimants’ parents/guardians concerning supporting documentation needed for reimbursement or payment requests. 

• Communicate denial decisions to admitted claimants’ parents/guardians or vendors when necessary and provide information to them concerning rights to appeal Program decisions. 

• If an appeal is to be presented to the Program’s Board, the Claimant Outreach Coordinator will be responsible for scheduling the matter on a Board Meeting Agenda, assisting the admitted claimant’s representative with having any material that was submitted for consideration available to the Board members, and then communicating the Board’s decision to the admitted claimant’s representative thereafter.  If the matter is not resolved to the parties’ mutual satisfaction at that juncture, the Claimant Outreach Coordinator would provide information to the admitted claimant’s representative concerning the right to appeal the matter to the Virginia Workers’ Compensation Commission.   

• Undertake regular clinical training from time to time to maintain good practice, increase knowledge and skills and to optimize performance. 

• Must maintain a high level of confidentiality and abide by HIPAA rules and regulations. 

• Serving as the Program’s official Records Custodian by managing the Program’s records in accordance with the Virginia records management and retention requirements, including proper storage/archiving, retrieval upon request, and preparing responses to subpoenas after consultation with the Program’s legal counsel and with the Executive Director’s approval. 

• Perform other duties as assigned. 

Qualifications: 

• Must have outstanding customer service and solid oral and written communication skills.  

• Must have an appreciation for the needs of families with birth-related injuries. 

• Previous claims processing experience, ideally nonprofit or insurance company. 

• Must understand work towards client rehabilitation and enjoy working as part of a multi-disciplinary team. 

• Ability to stay calm in potentially stressful situations. 

• Excellent written and verbal communication skills. 

• Proficiency in Microsoft Office Suite and other relevant software applications. 

Education & Experience: 

• Bachelor’s degree in human services or related field, and/or a professional clinical certification. 

• Minimum of 5 years’ relevant work experience in claims and/or a clinical environment. Preferably working with children or people with disabilities and/or chronic illnesses. 
   

The Virginia Birth Injury Program is an Equal Opportunity Employer. The Virginia Birth Injury Program does not discriminate in hiring or employment practices based on race, color, religion, gender, age, sexual orientation, marital or family status, national origin, non-job-related disability, or status as a veteran.