Sr. Worker's Comp 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 workers’ compensations.
• 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.
• Provide advice and counsel regarding claims management, claim compensability and/or settlement strategies with Medline, TPAs, nurse case managers and defense attorneys.
• 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.
• Ensure accurate and timely reporting of all workers’ compensation claims by all employees and management to the appropriate vendor or state agency.
• 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.
• Collaborates closely with the Workers’ Compensation Manager in developing business unit risk management strategies, placement, and management of Workers’ Compensation program for the Network
• Provide insightful and comprehensive risk management consulting services to business areas including return-to-work timelines, new acquisition compliance, lost time tracking, and safety reviews of work environments.
• 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: Minimum of 5 years’ experience handling New York State workers’ compensation claims.

 

Education: Associates Degree, required. Bachelor’s Degree, preferred.

 

Licenses / Certifications: 

 

Other: 

 

 

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 time management skills to investigate and give a report on claims within a given time frame.
• Ability to lead and work effectively and collaboratively within team settings and build partnerships both internal and external.
• Effective deliberation and negotiating skills resulting in successful outcomes.
• 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 verbal and written communication skills to effectively communicate with co-workers, supervisors and managers.