Job Details
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:
- 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
Qualifications:
- 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