Claims Specialist - # 26-24738

Job Description

Job Description

Duration: 12 Months Contract

Please Note: . The position is located at the project  construction site in Winnemucca, Nevada  , and is not remote work (Day 1 Onsite). The anticipated work schedule is  Monday through Saturday, 6:00 a.m. to 4:30 p.m.

Overview :
The Claims Administrator is responsible for implementing all aspects of the project workers’  compensation program under the guidance of Client's claims team. This position will also assist  with the administration of auto and other insured claims. While this is Client's contingency position, the employee is seconded to Client's . The Claims position works under the direction of Client's Head of   Workers' Compensation and the Client's Claims Director, acting independently to manage routine matters  while keeping Client's Claims fully informed at all stages. 
Responsibilities:

• Communicates effectively with injured workers, medical professionals, insurers, brokers,  
• internal/external counsel, corporate management, and various related regulatory agencies.
• Develops and maintains project-specific workers’ compensation claims manual, compliance of ESIS NV provider panel, related processes and procedures for statutory claims.
• Implements improvements based on lessons learned, legislative changes or Court decisions, and Client's operating imperatives. 
• Develops and provides onsite training related to workers’ compensation. 
• Monitors claims activity to identify early negative claim trends or other issues that may negatively impact project performance. 

Responsible for oversight and processing of workers’ compensation claims: 

• Responsible for initiating, preparing, and maintaining all documentation associated with claims. 
• Investigates and documents eligibility for workers’ compensation benefits and communicates same to insurer and related interested parties. 
• Assists with investigation and coordination of issues surrounding subrogation. 
• Interprets laws and regulations, determines appropriate courses of action, and presents solutions to resolve the claims. 
• Identifies potential subrogation issues, for internal discussion and next steps. 
• Monitors claim resolution activities implemented by insurer(s).  
• Maintains Project Risk Management Information System (RMIS). 
• Directs and monitors the activities and performance of Client's insurance provider to ensure compliance with applicable regulations.
• Implements, monitors, and ensures compliance of “Special Account” requirements.
• Conducts regular claim reviews, claim audits and prepares related reports.
• Interfaces with insurer to effectively manage claims, including but not limited to authorizing claim reserve changes, authorizing insurer referral to outside counsel, and assessing and approving settlement strategies.
• Coordinates and supports early return to work.
• Manages relationships with onsite clinic, panel physicians and other medical providers, to ensure effective claims management and return to work. 
• Works with injured worker and supervision on developing and implementing return to work plan.
• Assists in management fitness for duty and ADA accommodation issues as needed.
• Assists Client's Risk Management in the defense of litigation or other complex case support. (i.e., responding to interrogatories and other discovery requests).
• Assists with gathering information and filing other insured claims as requested.  
• Performs other tasks as required by Client's Claims. 

Requirements:

• Requires a Bachelor’s Degree or at least 3 years of experience in the field or in a related area.
• Extensive knowledge of / experience with workers’ compensation and occupational rehabilitation procedures, practices and processes.
• Extensive knowledge of claim’s resolution techniques and strategies, legal principles
• related to claim resolution and familiarity with all phases of the litigation process.
• Working knowledge of / experience with bodily injury and 1st and 3rd party property damage claims practices and processes. 
• Working knowledge of / experience with and other insured claims practices and procedures. 
• Relies on experience and judgment to plan and accomplish goals. 
• Highly skilled in written and verbal communication. 
• Proficient with computer skills and knowledge.   
• Ability to create, edit, and format high-quality documents using Microsoft Word 365  applications (Outlook, Word, Excel, Power Point, etc.) 
• Collaborate with team members in real time through Outlook and Teams applications.
• Typing skills / proficiency (45-65 WPM). 
• Bilingual language proficiency (i.e., English and Spanish) is a plus. 

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US Tech Solutions is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, colour, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.

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