Workers Compensation Claims Analyst

Department: 10604 Enterprise Corporate - Workers Compensation

Status: Full time

Benefits Eligible: Yes

Hours Per Week: 40

This is a hybrid role requiring in-person meetings in Charlotte and offering work from home opportunity. Monday through Friday from 8:00am to 5:00pm.

Pay Range $30.15 - $45.25

The Workers Compensation Claims Analyst is a critical thinker who manages claims within organizational standards and best practices. They are responsible for the adjudication of medical only claims and limited lost time workers' compensation claims. They will work closely with case managers, attorneys, and vendors. They will manage subrogation liens and negotiate claim settlements to achieve the best possible outcome and support the goals of the department.

• 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, evaluate and determine compensability of workers’ compensation claims within the statutory period for multiple jurisdictions.
• Must be able to monitor and control costs, document the electronic claim file and claim outcome in a timely manner, reserve files, manage subrogation and litigation, file appropriate forms and pay all benefits due within statutory periods, and coordinate 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 or 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 maintain strict confidentiality of information at all times of a sensitive nature and/or protected under state and federal law.
• Must develop and maintain professional customer relationships, provide education as needed, and serve as a mentor to other adjusters and stakeholders.
• Must provide additional support for additional projects and duties as assigned.

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

• Competent in workers’ compensation rules, regulations, and laws for multiple jurisdictions.
• Work with a sense of urgency and accuracy.
• Evaluate and determine compensability of workers’ compensation claims within statutory limits for multiple jurisdictions.
• Work independently as well as part of a team.
• Access to protected Health Information (PHI) only as necessary; information shared 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 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…