Sr. Worker's Comp Specialist

North East Provider Solutions Inc.
· Leave Management- WMC Health Valhalla, NY Professional/Non-Clinical Full TimeDayM-F 9-5

Job Summary:

Under the direction of the Sr. Director of Leave Management, the Workers’ Compensation Specialist will utilize knowledge of Workers’ Compensation to independently investigate, evaluate and resolve assigned claims of a more complex nature in order to achieve appropriate outcomes.  In this position the Specialist will manage and resolve Workers’ Compensation claims in a timely manner in accordance with legal statues, policy provisions, and organizational guidelines.  

In addition, the Workers’ Compensation Specialist will manage a caseload of claims from inception to closing or settlement. Responsibilities:

Serves as the subject matter expert for workers’ compensations.

Acts as the primary point of contact for each injured employee for the duration of their workers’ compensation claim; acts as liaison between injured employee and workers’ compensation adjuster; and follows up with injured employee as needed to ensure claim is progressing properly.

Investigates claims to determine an injured worker’s entitlement to Workers’ Compensation benefits; administers indemnity and medical benefits for valid Workers’ Compensation claims. Provide advice and counsel regarding claims management, claim compensability and/or settlement strategies with Medline, TPAs, nurse case managers and defense attorneys.

Responsible for receiving, organizing, and analyzing all files and documents related to the injured worker and the injury in order to make an effective and accurate determination concerning the claim.

Performs interview with the injured employee to obtain a detailed description of how the injury occurred.

Performs interview with the employee’s supervisor to verify the description of the incident and what could have been done to prevent the incident.

Conducts investigations of alleged fraudulent activity of all leave cases and workers' compensation.

Contacts the employee immediately following the initial medical treatment for diagnosis, prognosis, and expected period of disability, if any.

Analyzes and processes workers’ compensation claims by investigating and gathering information to determine compensability and exposure. Ensure accurate and timely reporting of all workers’ compensation claims by all employees and management to the appropriate vendor or state agency.

Reviews and maintains personal diary on claims.

Maintains weekly telephone contact with the employee while off work and treating.

Investigates, evaluates and strategizes on resolution of non-litigated matters.

Compiles and reviews claim data; identifies risk exposures through evaluation of loss statistics and trends.

Collaborates closely with the Workers’ Compensation Manager in developing business unit risk management strategies, placement, and management of Workers’ Compensation program for the Network Provide insightful and comprehensive risk management consulting services to business areas including return-to-work timelines, new acquisition compliance, lost time tracking, and safety reviews of work environments.

Keeps Manager informed verbally and in writing of activities and problems within assigned area of responsibility; refers matters beyond limits of authority and expertise to Manager for direction.

Reports claims to the excess carrier when applicable.

Coordinates return to work (RTW) and sets target dates.

Documents files in the Leave Management systems.

Effective and timely coordination of communication with supervisors/managers, claimants and other appropriate parties throughout the claim process. Perform other duties as assigned or required.

Qualifications/Requirements:

Experience:

Minimum of 5 years’…