Workers Compensation Claims Analyst Associate

The Workers Compensation Claims Analyst Assoc is a critical thinker who manages claims within organizational standards and best practices. They are responsible for the adjudication of medical only claims and provides superior customer service to achieve the best possible claim resolution. They will also provide support to the claims department and serves as a backup to the claim administrator when needed. They are responsible for determining compensability and identifying incidents that need to be escalated for more in depth investigation. ​

Major Responsibilities:

• ​​​Must possess analytical skills and be able to work with a sense of urgency and accuracy. Must be able to adhere to multiple state workers' compensation rules, regulations, and laws.​
• ​​Must be able to complete appropriate contacts within 24 hours of assignment, establish and maintain appropriate diary for follow-up, evaluates and determines compensability of workers' compensation claims within the statutory period for multiple jurisdictions.​​​ ​​
• Must be able to be responsible for monitoring and controlling costs, timely documentation of the electronic claim file, claim outcome, timely reserving of files, managing subrogation and litigation, filing appropriate forms and payment of all benefits due within statutory periods and coordinates light duty as needed.​​
• Must be a resource to injured teammates, leaders, and others with an interest in the claim. Must be able to report appropriate claims to Teammate Safety for investigation.
• ​Must be able to approve payments, answer phone calls, authorize treatment related to claim.
• ​Must be able to determine whether treatment is appropriate and causally related to the compensable injury and redirecting treatment to network physicians as appropriate.
• ​Must be able to refer subrogation potential claims or potential permanency claims to higher level claim specialist
• ​Must be able to maintain strict confidentiality of information at all times of a sensitive nature and/or protected under state and federal law.
• ​Must be able to provide additional support for other projects and duties as assigned.

Education Requirements:

• ​Adjusters license for assigned jurisdiction as required by specific jurisdiction as applicable.​
• High school diploma; Bachelor's degree preferred.

Experience Requirements:

• One or more years of Workers' Compensation and/or Liability claims handling experience preferred.

Knowledge, Skills & Abilities Required:

• ​​​Must be competent in workers' compensation rules, regulations, and laws for multiple jurisdictions. ​
• Must work with a sense of urgency and accuracy.
• Must be able to work independently.
• Must have familiarity with medical terminology
• Must be able to manage multiple tasks simultaneously, make tough decisions and focus on details.
• Must have excellent verbal and written communication skills.
• Must be proficient in Microsoft Office products.
• Limited access to protected health information (PHI) to the information necessary to do the job.
• Sharing of information only on a need-to-know basis for work purposes.

This job description indicates the general nature and level of work expected of the incumbent. It is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities required of the incumbent. Incumbent may be required to perform other related duties.