- Conducts and properly document all incident /accident investigations into our RIMIS system. Ensures the TPA thoroughly and properly investigates all initial claims. Monitor to ensure that TPA follows appropriate state workers compensation laws and defenses
- Within the scope of authority, reviews and authorizes worker's compensation settlement offers to be made by the TPA
- Effectively monitors medical and disability claim authorizations and payments to ensure their appropriate and accurate
- Reviews costs associated with all claims handling and developing strategies to improve performance
- Works with TPA to move claims toward closure
- Partners with Safety, Human Resources and Corporate Legal to drive claims management
- Makes appropriate referrals to outside vendors such as defense attorneys, nurse case managers and investigator
- Coordinates the employee's release to transitional duty with the Return-to-Work Specialist and the Field Office.
- Obtains evidence in contested and/or litigated claims to assist outside attorneys to defend claim and to prepare for trial
- Initiate subrogation where appropriate with management's authorization
- Prepares for and attends Claim Review Conference with TPA to evaluate individual cases; reviews, and adjusts financial reserves of claims; negotiates with TPA the settlement of claims within established authority and work together to develop detailed and doable Plans of Actions
- Conducts bi-annual audits to ensure TPA is meeting their best practices requirements
- Review reserves and provide authorization to TPA, where appropriate within authority
- Reviews performance of external vendors in the areas of claims administration, manages litigation and make recommendation to Workers Compensation Compliance Supervisor for adjustments
- Monitors and reviews workers compensation claims and the claims processing; identifies claims management trends and inefficiencies and make recommendation as needed
- Participates in developing strategies to reduce claims frequency and severity
- Establishes and maintains a file and diary on all open claims
- Participates in communicating claims trends to Regional Safety Manager
- Working with Compliance Supervisor to develop and conduct training to field offices regarding workers compensation issues and process
- Attends training sessions, conferences, and workshops to keep abreast of current practices, programs, and legal issues for the purpose of conveying and/or gathering information required to perform functions
- Authority level for settlements up to $70,000
- Authority level for reserves up to $80,000
- High school diploma and 3 years work experience in insurance, workers compensation claim management or risk management or
- Associate in Arts / Sciences and 2 years; experience in workers compensation, or risk management or related field or
- Bachelor's Degree with 2 years; work experience in insurance, workers compensation claims management or risk management
- Ability to learn TPA system & generate requested reports
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Entry Level Workers Compensation Specialist - Tempe, United States - Aerotek
Description
Aerotek has an immediate opening for a Claims Review Specialist - Workers Compensation at the corporate office in Tempe, AZ.
About this role...
Full Time | Monday - Friday
Hybrid Schedule | 4 days in office - 1 day remote
Job Summary:
Reporting to the Workers Compensation Compliance Supervisor and Workers Compensation Compliance Manager, the Claims Review Specialist will assist in the monitoring and administering of Aerotek's workers compensation program to ensure the maximum cost containment. Seek to ensure that Third Party Administrator (TPA) is managing claims efficiently.
Essential Functions:
Qualifications:
