Workers' Claims Analyst

Department: 10604 Enterprise Corporate - Workers Compensation

Status: Full time

Benefits Eligible: Yes

Hours Per Week: 40

Schedule Details/Additional Information:

Monday-Friday, 40 hours per week between 8:00 a.m.

- 5:00 p.m. Hybrid remote.

Pay Range

$30.70 - $46.05

• Must possess analytical skills and be able to work with a sense of urgency and accuracy. Must be able to adhere to multiple state workers’ compensation rules, regulations, and laws.
• Must be able to complete appropriate contacts within 24 hours of assignment, establish and maintain appropriate diary for follow-up, evaluates and determines compensability of workers’ compensation claims within the statutory period for multiple jurisdictions.
• Must be able to be responsible for monitoring and controlling costs, timely documentation of the electronic claim file, claim outcome, timely reserving of files, managing subrogation and litigation, filing appropriate forms and payment of all benefits due within statutory periods and coordinates light duty as needed.
• Must function as a resource to the injured teammates, leaders, and others with an interest in the claim.
• Must be able to communicate claim status with the injured teammate and other parties, as necessary.
• Must be able to develop action plans and strategies for prompt payment/denial of claims bringing them to a timely conclusion while providing all appropriate information. Must be able to monitor and report appropriate claims to excess carriers.
• Must be able to determine what treatment is appropriate and causally related to the compensable injury and redirect treatment to network physicians as appropriate. Must be able to promptly authorize and approve related expenses of the claim.
• Must be able to maintain strict confidentiality of information at all times of a sensitive nature and/or protected under state and federal law.
• Must be able to develop and maintain professional customer relationships. Must be able to provide education as needed and serve as a mentor to other adjusters and stakeholders.
• Must be able to provide additional support for additional projects and duties as assigned.

• Adjusters license for assigned jurisdiction as required by specific jurisdiction as applicable.
• 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.

• Must be competent in workers’ compensation rules, regulations, and laws for multiple jurisdictions.
• Must work with a sense of urgency and accuracy.
• Evaluates and determines compensability of workers’ compensation claims within the statutory limits for multiple jurisdictions.
• Must be able to work independently as well as part of a team.
• Access to protected Health Information (PHI) to the extent of information necessary to do the job. Information shared only on a need-to-know basis.

This job description indicates the general nature and level of work expected of the incumbent. It is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities required of the incumbent. Incumbent may be required to perform other related duties.

Advocate Health offers a comprehensive suite of Total Rewards: benefits and well-being programs, competitive compensation, generous retirement offerings, programs that invest in your career development and so much more – so you can live fully at and away from work, including:

• Base compensation listed within the listed pay range based on factors such as qualifications, skills, relevant experience, and/or training
• Premium pay such as shift, on call, and more based on a teammate's job
• Incentive pay for select positions
• Opportunity for annual increases based on performance

• Paid Time Off programs
• Health and welfare benefits such as medical, dental, vision, life, and short- and long-term disability
• Flexible Spending Accounts for eligible health care and dependent care expenses
• Family benefits such as adoption assistance…