Job Description

Job Description

Workers Compensation Claims Specialist

Property and Casualty Insurance Industry

Oversee insurance carriers and Third-Party Administrators (TPAs) in their management and handling of affiliated clients’ Workers’ Compensation claims in an assigned geographic region of the country based upon program and compliance regulations.

Knowledge of workers’ compensation policy and manage incidents, and dispatch nurse case managers as necessary. Collaborate closely with Risk Management leadership on workers’ compensation claims, process, and procedures to ensure integrated program.

Responsibilities

• Serve as resource for injured employees and inform of workers’ compensation process and procedures.
• Report workers’ compensation claims to carriers and Third-Party Administrators (TPAs), including notification of questionable claims.
• Facilitate proactive identification of claims with opportunities for early Return to Work and light duty Return to Work program, as needed.
• Evaluate and respond to Reserve and Settlement Consultations within given authority, escalate consultations above scope authority to appropriate leadership.
• Maintain diary for open claims and document specific claim related activities in Risk Management information system.
• Work with carriers, TPAs, and Defense Counsel to develop mitigation strategies for Owner Controlled Insurance Program (OCIP) that result in cost savings to the claim, ensure aggressive strategy is developed on litigated claims, and bring claims to timely resolution.
• Collaborate with General Liability team to develop mitigation strategies and facilitate most economic global resolution of Contractor Controlled Insurance Program (CCIP) claims.
• Attend hearings and mediations on as needed basis.
• Ensure avenues for potential claim recovery are identified and pursued and manage lien recovery on case-by-case basis.
• Participate in claims review process and monitor claims handling process by carriers and TPAs; provide direction to ensure compliance with best practices and special handling instructions.
• Oversee and hold vendors and defense firms accountable for adherence to standard protocols, agreed to service instructions, and litigation management guidelines.
• Update instructions and guidelines and provide recommendations to appropriate leadership.
• Partner with Safety team and onsite medics on initiatives that support worker wellness and post-injury care.
• Participate in CCIP kickoff meetings and jobsite walkthroughs, attend Claims, Safety and Operations meetings to monitor current and anticipated project risks and report on claims status for specific projects.
• Maintain and foster relationships with carriers and TPAs claims teams.
• Assist with claim data analysis and claim performance reports.
• Collaborate with HR and Payroll departments for completion of required Workers’ Compensation Jurisdictional Forms.
• Support audits related to workers’ compensation claims.
• Remain current on Workers’ Compensation laws and regulations, industry trends, and case law within assigned jurisdictions.

Qualifications

• Bachelor Degree in Insurance, Risk Management, Finance, Business Administration or related program; with minimum of 8 years of workers’ compensation claims administration experience in New York City and State jurisdiction; or equivalent combination of education, training, and/or experience.
• Experience with workers’ compensation claims in a construction environment, desired.
• CRIS, ARM or similar insurance designation, desired.
• Knowledge of jurisdictional laws and regulations for assigned territory.
• OSHA (Occupational Safety and Health Act) knowledge and experience desired; OSHA 30-hour certification, a plus.

Required Skills

• In-depth knowledge of workers’ compensation claims, medical management procedures, medical cost containment programs and applicable laws and regulations.
• Demonstrate process thinking and sound decision-making skills.
• Analytical and adept at processing and breaking down data into actionable information.
• Self-starter with strong project management skills and capable of managing concurrent complex projects and tasks successfully to completion.
• Demonstrate strong interpersonal and teamwork skills with ability to work with individuals across organizational levels, both internal and external.
• Professional written and verbal communication, and effective presentation skills.
• Proficient computer skills, Microsoft Office suite of applications, and insurance-based risk management information systems.

This is a remote position with some travel required.

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