Summary:
This position is responsible for overseeing Workers Compensation and Leave data entry through the appropriate databases and tracking systems, review and inform employees of their specific benefits and leave policies, communicate and coordinate with employee and management on return to work and modified duty activity, and other required activities.
Essential Duties and Responsibilities:
- Enter claims in TPA's database. Work with associates to obtain all necessary paperwork in a timely manner
- Maintain claims management system for tracking open claims and related activities
- Handle lost time and indemnity status claims. Communicate regularly with employees losing time or on light duty. Provide information and regular feedback to sites regarding employees on leave (i.e. anticipated return to work, medical progress, etc.)
- Advise employees on their specific benefits, responsibilities and requirements. When necessary send certified offer letters to employees offering light duty assignments when medical provider indicates modified duty, and send other necessary communication to employees
- Ensure compliance with applicable regulatory requirements for states that maintain state-run programs
- Complete and maintain records and reports required for claims
- Track data related to key trends and opportunities in the workers’ compensation program. Maintain dashboard metrics that demonstrate the overall health of program
- Process incoming calls, emails and system notifications regarding claims
- Monitors claims for accuracy by reviewing claims filed by employees for completion and timely submission related to incidents
- Delivers communication with employees, managers, insurance carriers, medical staff and legal as needed
- Provide employees/managers with information and assistance regarding potential leaves
- Analyze the needs of claim files and set diaries for completion of tasks
- Coordinate return to work between employee and TPA's
- Coordinate return to work with restrictions or modified duty following process in place
- Coordinate leaves with Short Term Disability department and Workers’ Compensation Claims Teams to properly administer concurrent leaves
- Update employee records by communicating with HR/Payroll as appropriate
- Escalate issues to the proper management resource as appropriate
- Performs other duties as assigned
Requirements:
Education and/or Experience, Knowledge, Skills & Abilities:
To perform this job successfully, an individual must be able to perform each essential job duty satisfactorily. The requirements for this position are listed below:
- Multi-state workers’ compensation claims handling experience
- Ability to interact and work effectively with internal staff, external advisors and stakeholders
- Ability to make effective, well-reasoned decisions in a team environment
- Excellent verbal and written communication skills
- Prior claims and/or leave management experience
- Ability to understand claim notes in claim files
- Ability to review and analyze the financial data of the claim file a plus
- Knowledge of FMLA regulations and requirements is highly desired
- Must have a strong disposition toward customer service and proven aptitude for computer-based leave transaction processing
- Candidate must have exemplary organizational skills.
- Working knowledge of the use of the ESIS or related claim management system
- Ability to use SharePoint, Access and Excel
Preferred Qualifications:- A minimum of a Bachelor’s Degree; experience in lieu of degree.
- 5 or more years of professional experience in Workers Compensation and/or Leave Administration is preferred.
Required experience is commensurate with the selected job level:- The Specialist/Analyst level requires a Bachelor’s degree or equivalent experience and 2-5 years of relevant job related experience
- The Senior Specialist/Analyst level requires a Bachelor’s or equivalent experience and 5-8 years of relevant job related experience
- The Lead Specialist/Analyst level requires a Bachelor’s or equivalent experience and 8+ years of relevant job related experience
Working Conditions:
The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job.- Usually, normal office working conditions.
- Must be able to remain in a stationary position 50% of the time due to prolonged periods of sitting or standing.
- Occasional overnight travel may be required.
- Occasional visits to industrial/manufacturing settings, which may include exposure to various materials and chemicals, as well as extreme temperature conditions and loud machinery, and require appropriate personal protective equipment.
Equal Opportunity Employer/Disability/Vet
DISCLAIMER: The above statements, which are subject to change, are intended to describe the general nature and level of work being performed by people assigned to this job. They are not intended to be an exhaustive list of all responsibilities, duties and skills required of personnel so classified.
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