Claims Analyst Workers Comp

Job Description

Description

Job Summary:

The Claims Analyst handles workers compensation claim file caseloads for multiple jurisdictions and/or oversees the technical quality of third-party claim administrators on bundled, unbundled, excess, and reinsurance assumed workers' compensation claims.  Specifically oversees each catastrophic, high exposure, and emerging issue claim that requires special attention and expertise. Participates in design, measurement, and execution of regular WC claim quality audits of TPAs, as well as follow-up action plans. Ensures that monthly claim data received is within industry standards and that claim handling fee charges are in accordance with the TPA's contract with us. Assists when needed to ensure quality control of Serious Loss Reports (SLR) submitted by Workers Comp Claims Specialists where the total dollar incurred is over $300,000 dollars.

Essential Job Functions:

A. Handles hybrid caseloads for workers compensation claims in multiple jurisdictions.

• Confirm coverage and policy information.

• Establish proper loss reserve, negotiate loss settlement (when applicable) and bring cases to resolution.

• Maintain control of outside vendors/attorneys and their expenses by directing assignments to them and limiting their scope to maximize cost effectiveness while minimizing delays in claims handling.  Such vendors/attorneys must not be used unless pre-approved by the department manager.

• Maintain compliance with Workers' Compensation procedure and requirements established by regulatory authorities.

• Pursue Workers' Compensation liens and subrogation when appropriate.

• Maintain compliance with claims practice rules and internal instructions.

• Keep manager advised of significant developments in claims.

• Answer correspondence and inquiries promptly from brokers/agents, insureds, claimants, doctors, attorneys, outside vendors, TMM employees, etc.

B. As needed, oversee the technical quality of third-party claim administrators on bundled, unbundled, excess, and/or reinsurance assumed workers' compensation claims.

• Oversee each catastrophic, high exposure, and emerging issue workers' compensation claim that requires special attention and expertise. Extend authority as necessary.

• Timely and accurate report claims in excess of authority to those with higher levels of authority.

• Participate in design, measurement, and execution of regular WC claim quality audits of TPAs. Monitor and measure action plans to improve results.

• Review and evaluate monthly data received from TPAs to confirm its compliance with industry standards.

• Review claim handling fees charged by TPAs for compliance with our TPA contracts.

• Periodically review TPA data in ClaimsCenter for accuracy of entry.

• Participate in design and delivery of WC claims technical training, especially to TPAs.

• Participate in WC claim outcome benchmarking.

C. Assist with SLR reports submitted by Claims Specialists in the Workers Comp Department to continue to improve our SLR process so that submissions are completed timely, accurately and thoroughly.

D. Responsible for complying with proper internal controls as necessary to conduct job functions and/or carry out responsibilities and/or administrative activities at Company.

Qualifications:

• Bachelor's degree preferred 

• Minimum of 10 years technical experience handling workers compensation claims.

• Must have active applicable state insurance claims adjuster license and the ability to maintain required licenses as required by law

• Word and Excel knowledge

• Excellent communication and interpersonal skills (both internal and external)

Salary range of $95k - $118k. Ultimate salary offered will be based on factors such as applicant experience and geographic location. Our company offers a competitive benefits package and bonus eligibility on top of base.