Workers' Compensation Claims Analyst

About the role

A critical-thinking Workers Compensation Claims Analyst who manages claims within organizational standards and best practices, adjudicating medical-only and limited lost-time workers’ compensation claims. Works closely with case managers, attorneys, and vendors to manage subrogation liens and negotiate claim settlements.

Responsibilities

• Adhere to multiple state workers’ compensation rules, regulations, and laws.
• Complete appropriate contacts within 24 hours of assignment; establish and maintain diaries for follow-up.
• Evaluate and determine compensability of workers’ compensation claims within statutory periods for multiple jurisdictions.
• Monitor and control costs; ensure timely documentation of the electronic claim file, claim outcome, and reserving of files.
• Manage subrogation and litigation; file appropriate forms and pay all benefits due within statutory periods.
• Coordinate light-duty assignments as needed.
• Act as a resource for injured teammates, leaders, and other stakeholders.
• Communicate claim status with injured teammates and other parties.
• Develop action plans and strategies for prompt payment or denial of claims, ensuring timely resolution.
• Monitor and report appropriate claims to excess carriers.
• Determine appropriate and causally related treatment; redirect treatment to network physicians as needed.
• Promptly authorize and approve related claim expenses.
• Maintain strict confidentiality of sensitive information protected under state and federal law.
• Develop and maintain professional customer relationships.
• Provide education and serve as a mentor to other adjusters and stakeholders.
• Support additional projects and duties as assigned.

Requirements

• Adjusters license for assigned jurisdiction as required.
• Bachelor’s degree required or a combination of education and related experience.
• 2–5+ years’ experience managing progressively difficult Workers Compensation lost-time claims.
• Associates in Claims designation preferred.

Skills

• Competency in workers’ compensation rules, regulations, and laws for multiple jurisdictions.
• Ability to work with urgency and accuracy.
• Evaluates and determines compensability of claims within statutory limits for multiple jurisdictions.
• Works independently as well as part of a team.
• Access to protected Health Information (PHI) on a need-to-know basis.