Under minimal supervision, this position investigates Workers' Compensation (WC) claims, Premises Liability, Hospital Professional Liability, and Auto Liability claims and reports, and information provided to third-party administrators to ensure compliance with federal and state regulations and organizational policies. Monitors claim activities to conclusion in effort to reduce the financial impact to the organization.
Primary Duties and Responsibilities
Prepares, reviews, and submits reports regarding claims for WC, Premises Liability, Hospital Professional Liability, and Auto Liability.
Verifies data received from facilities, finance, and payroll departments for submission to insurance carriers on workers’ compensation.
Coordinates and monitors the activity of vendor partners as it relates to individual claim outcomes.
Monitors, maintains, and reviews all claims in designated states for timely and accurate reporting including, but not limited, to employee status, case reserving and litigated status
Maintains the Occupational Safety and Health Administration (OSHA) log module in Risk Management Information System (RMIS).
Prepares, maintains and coordinates a variety of information with third party administrators including outstanding medical bills, employee lost time, employee return to work, and compensation data.
Completes and maintains all forms and documents related to Workers' Compensation, Premises Liability, Hospital Professional Liability, and Auto Liability.
Works closely with the Human Resources Department and Director, Risk Management to assist in early claims reporting and for designated claims that are in the litigation process.
Schedules, assists, and participates in claims file audits.
Assists and monitors the Modified Duty Program and all associated costs.
Performs other duties as assigned.
High school diploma or equivalent. Bachelor’s degree desirable.
Two (2) years of experience in Worker's Compensation claims management.
Proficient with claims database applications.
Demonstrated knowledge of claims adjusting principles and practices with emphasis on multiple-state WC law.
Excellent verbal and writing skills.
Demonstrate strong organizational and time-management skills.
Ability to work with computers and the necessary software applications used by the department.