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With a history dating back to 1886, American Water is the largest and most geographically diverse U.S. publicly traded water and wastewater utility company. The company employs more than 7,000 dedicated professionals who provide regulated and market-based drinking water, wastewater and other related services to 15 million people in 46 states. American Water provides safe, clean, affordable and reliable water services to our customers to help make sure we keep their lives flowing. For more information, visit amwater.com and follow American Water on Twitter, Facebook and LinkedIn.
Primary Role
The Workers’ Compensation Claims Analyst will diligently monitor pending workers’ compensation claims across all jurisdictions with operations under the enterprise to provide guidance and recommendations to the 3rd party WC insurance carrier/claims administrator (hereinafter “insurer”), Insurance Claims Manager and Director of Risk Management. Such guidance and recommendations shall include the appropriate medical management track/treatment plan, timely return to work/compliance with light duty accommodations, analysis of potential credits and/or subrogation opportunities, reserve adjustments, selection and retention of medical experts, expense cost review, and the optimal case resolution strategy/indemnity evaluation to help achieve the Claims COE primary objective to drive reduction in Total Cost of Risk (“TCOR”). This will be a full-time temporary role for approximately 5 months. The ideal candidate will work remotely from their home office.
Key Accountabilities
Assists the insurer, Insurance Claims Manager and Director of Risk Management with claim analysis including:
Monthly evaluation of all high exposure claims with the assigned claims adjuster to approve/reject/revise the POA, or plan of action (e.g. medical treatment, prior medical/prior loss impact analysis, surveillance/SIU/fraud, retention of experts/IME/DME, return to work/light duty accommodations, indemnity/expense reserves).
Quarterly evaluation of all mid-level and low level exposure claims with the assigned adjuster to approve/reject/revise the POA (e.g. medical treatment, prior medical/prior loss impact analysis, surveillance/SUI/fraud, retention of experts/IME/DME, return to work/light duty accommodations, indemnity/expense reserves).
Reviews/Revises/Supplements the Settlement Authorization Forms prepared and submitted by the assigned claims adjuster for claims subject to same per the approved Special Account Claim (“SAC”) handling guidelines to provide settlement or optimal case resolution recommendations to the Insurance Claims Manager and Director of Risk Management.
Supports the Insurance Claims Manager and Director of Risk Management in the annual audit of the insurer and other workers’ compensation claim file reviews as assigned.
Assists LOA/HR team with transfer of WC data (e.g. lost time, modified duty, medical status) across all regions.
Performs special assignments as assigned by the Insurance Claims Manager.
Provides support (or coverage) for the Insurance Claims Representative(s) on workers’ compensation claim intake/initial processing as needed or as required.
Accesses insurer’s online claims management data base and reporting portal to prepare and submit key claim management reports as requested by the Insurance Claims Manager and/or Director of Risk Management, including reports that address review of high-mid low level exposure based upon total incurred, adverse trending analysis, subrogation recovery, ALAE tracking, indemnity markers and other metrics/KPIs.
Evaluates, recommends and obtains settlement authorization from Director Risk Management for applicable claims pursuant to the approved SAC handling guidelines.
Knowledge/Skills
Demonstrates an understanding of Workers’ Compensation insurance policies coverage, terms, conditions and exclusions across all jurisdictions with operations under the enterprise.
Knowledge of insurance claims management process.
Knowledge of water utility and related services business risks preferred.
Proficiency with Microsoft products and knowledge of ORCOM and VERTEX.
Experience/Education
Experience in claims management within an insurance company, insurance broker or corporate risk management claims organization.
5 years general experience in risk management including 3 years in insurance claims management specializing in a multi-state high volume workers’ compensation claims program. Supervisory experience in a claims management program is preferred.
Supervisory skills including training and development. Excellent oral and written communication skills.
Proficiency in computer skills as well as ability to use more advanced analytical and program evaluation skills including accessing and creating reports from insurer's online claims data base.
Travel Requirements
Approximately 10%
Competencies
Champions safety
Customer obsessed
Cultivates innovation
Nimble learning
Drives Results
Collaborates
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American Water is firmly committed to Equal Employment Opportunity (EEO) and prohibits employment discrimination for employees and applicants based on his or her age, race, color, pregnancy, gender, gender identity, sexual orientation, national origin, religion, marital status, citizenship, or because he or she is an individual with a disability, protected veteran or other status protected by federal, state, and local laws.
