- Oversee and navigate the complete lifecycle of the workers' compensation claims, guaranteeing precise and punctual resolution.
- Evaluate and review all claim intake paperwork for accuracy.
- Ensure the claim files follow company best practices.
- Report on-the-job injuries of team members to the third-party administrator via online portal within 24-hours of receipt of injury.
- Maintain incident and claim information in the claims' assignment log and in the SharePoint folder.
- Monitor to ensure all the necessary paperwork is submitted to the third-party administrator.
- Communicate with injured team members, store administrators, store directors and insurance adjusters to provide updates on claims and medical status.
- Monitor the claims to ensure they are processed accordingly, and that proper medical treatment is provided to the injured team member.
- Provide support to store administrators/store directors for submission of transitional work report documents and ensure modified work restrictions are being followed.
- Investigate, address, and resolve any inconsistencies in the handling of the claims.
- Communicate to insurance adjusters, legal representatives, and other outside parties with questions involving medical/indemnity/litigated claims within 24 hours.
- Collaborate with the Safety Department when a workplace danger or safety risk is recognized for investigation and documentation.
- Prepare and analyze various reports - disbursement expenses such as replenishment and claim activity payments from Third Party Administrators.
- Adhere to strict confidentiality and ethical standards when handling sensitive claim information.
- Other projects and duties as assigned.
- High School Graduate (college degree, professional certifications and licenses preferred).
- Minimum 1-3 years of claims management experience; workers' compensation preferred.
- Must be bilingual in Spanish including in writing.
- Attention to detail and thoroughness of work completed.
- Positive attitude and ability to manage multiple tasks at once.
- Timely execution of deliverables.
- Proficiency in typing required.
- Basic to intermediate proficiency with Microsoft Office applications.
- Excellent communication, collaboration, organizational, and critical thinking skills.
- While performing the duties of this job, the employee is regularly required to sit, stand, and use the hands to handle objects, tools or controls.
- Successful performance requires vision abilities that include close vision and the ability to adjust focus.
- The work environment is that typical of an office.
- Ability to lift up to 10lbs.
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Claims Specialist - Ontario, United States - Heritage Grocers Group
Description
At Heritage Grocers Group, LLC, how we work is defined by shared values that include absolute integrity, respect, and collaboration. But it's more than that, it's smart and highly driven people united in purpose to serve one another.
Bring your energy and unique perspective and you'll have the opportunity to grow with us professionally, personally, and financially. You'll be part of a team that genuinely cares about helping you succeed, and you'll work alongside talented colleagues, while making a difference in our communities.
POSITION SUMMARY:
The Claims Specialist will be responsible for directing, monitoring, and processing all workers' compensation claims for HGG business units. A successful candidate will provide high-level support and customer service to team members across the organization. Primarily communicating with store administrators, store directors, human resources department, industrial clinics, insurance adjusters and legal representatives.
ESSENTIAL DUTIES AND RESPONSIBILITIES:
The essential duties and responsibilities of this position include, but are not limited to, the following:
EDUCATION AND EXPERIENCE:
SKILLS AND QUALIFICATIONS:
PHYSICAL DEMANDS AND WORK CONDITIONS:
The physical demands and work conditions below represent those that must be met to successfully perform the essential functions of this job. Some requirements may be modified to accommodate individuals with disabilities:
IMPORTANT DISCLAIMER NOTICE
The job duties, elements, responsibilities, skills, functions, experience, educational factors, and the requirements and conditions listed in this job description are representative only and not exhaustive of the tasks that an employee may be required to perform. The Employer reserves the right to revise this job description at any time and to require employees to perform other tasks as circumstances or conditions of its business or the work environment change.
Disclaimer:
Pay Scale $22-$24.
The pay scale above is the salary or hourly wage range that the Company reasonably expects to pay for this position.
Within this range, individual pay is determined by location and other factors including, but not limited to, specific skills, relevant work experience, and relevant education and/or training. This information is provided to applicants in accordance with California Labor Code § 432.3 and state and local minimum wage standards.
