Workers' Compensation Specialist

Job Summary:

Under the direction of the Sr. Director of Leave Management, the Workers' Compensation Specialist will utilize knowledge of Workers' Compensation to independently investigate, evaluate and resolve assigned claims of a more complex nature in order to achieve appropriate outcomes. In this position the Specialist will manage and resolve Workers' Compensation claims in a timely manner in accordance with legal statues, policy provisions, and organizational guidelines. In addition, the Workers' Compensation Specialist will manage a caseload of claims from inception to closing or settlement.


Responsibilities:

• Serves as the subject matter expert for leaves, accommodations, and workers' compensation claims.
• Acts as the primary point of contact for each injured employee for the duration of their workers' compensation claim; acts as liaison between injured employee and workers' compensation adjuster; and follows up with injured employee as needed to ensure claim is progressing properly.
• Investigates claims to determine an injured worker's entitlement to Workers' Compensation benefits; administers indemnity and medical benefits for valid Workers' Compensation claims.
• Responsible for receiving, organizing, and analyzing all files and documents related to the injured worker and the injury in order to make an effective and accurate determination concerning the claim.
• Performs interview with the injured employee to obtain a detailed description of how the injury occurred.
• Performs interview with the employee's supervisor to verify the description of the incident and what could have been done to prevent the incident.
• Conducts investigations of alleged fraudulent activity of all leave cases and workers' compensation.
• Contacts the employee immediately following the initial medical treatment for diagnosis, prognosis, and expected period of disability, if any.
• Analyzes and processes workers' compensation claims by investigating and gathering information to determine compensability and exposure.
• Reviews and maintains personal diary on claims.
• Maintains weekly telephone contact with the employee while off work and treating.
• Investigates, evaluates and strategizes on resolution of non-litigated matters.
• Compiles and reviews claim data; identifies risk exposures through evaluation of loss statistics and trends.
• Keeps Manager informed verbally and in writing of activities and problems within assigned area of responsibility; refers matters beyond limits of authority and expertise to Manager for direction.
• Reports claims to the excess carrier when applicable.
• Coordinates return to work (RTW) and sets target dates.
• Documents files in the Leave Management systems.
• Effective and timely coordination of communication with supervisors/managers, claimants and other appropriate parties throughout the claim process.
• Perform other duties as assigned or required.

Qualifications/Requirements:

Experience:

• 2 years of progressively responsible administrative experience, required
• Experience in a worker's compensation, legal, insurance, medical or related field, preferred

Education:

• Associates Degree,required
• Bachelor's Degree, preferred.

Licenses / Certifications: N/A

Other: N/A

Special Requirements:

• Proficiency in Microsoft Office applications and familiarity with necessary tools such as spreadsheets.
• Strong organizational skills and demonstrated ability to prioritize work.
• Good investigation skills and submits reports on claims within a given time frame.
• Analytical thinking and particular attention to detail which enables to strategically handle investigations and tactically tackle issues.
• Adequate knowledge of relevant regulations and policies and procedures.

• Excellent written and interpersonal skills, including the ability to liaise effectively with workers, managers, and medical providers
• Excellent time management skills and the ability to prioritise in a dynamic and results-oriented environment

• Proven ability to work within a multidisciplinary team environment

Annual Salary Range: $74,833- $94,085