Workers' Compensation Specialist

Location

Duluth, GA | United States

Job description

The Workers’ Compensation Specialist is responsible for all workers compensation-related administration and the pro-active management of workers’ compensation claims to accelerate claim closure, mitigate risks, and manage financial exposure.

The ideal candidate has experience adjusting workers’ compensation lost time and medical only claims in an insurance company, third party administrator (TPA), or self-insured employer environment. T his position ensures compliance with applicable WC state laws, NDCP policies and procedures related to on-the-job injuries and collaborates/coordinates with the Company’s Leave Specialist to support compliance with WC, FMLA, and ADA integration .

1. Serve as the corporate point of contact for coordinating with the field workers’ compensation-related incident reporting to the TPA ensuring proper notifications are made to applicable parties and the HRIS system (ADP) is updated.
2. Process and maintain complete and accurate workers compensation-related incident and accident reports, documentation and files.
3. Serve as a key liaison with the Company’s third-party administrator’s claim representatives on all workers compensation-related data and information requests.
4. Establish initial contact with injured employees to provide an overview of the workers’ compensation process and NDCP coordination of benefits (ADA/FMLA/STD, etc.) thereby bridging the gap between NDCP and the third-party administrator (TPA).
5. Maintain contact with injured employees on an as needed basis to help with claim-related issues.
6. Maintain workers’ compensation reports and spreadsheets related to employee claim and work status.
7. Collaborate/coordinate with Company manager(s), HR business partners, and third-party administrator to facilitate and document modified duty assignments onsite and off-site through our return-to-work program.
8. Manage all return-to-work releases and related documentation and ensure that any return-to-work drug screens are completed in a timely and appropriate manner, coordinated through Safety Specialists.
9. Notify NDCP’s Leave and Benefits Specialists of all WC out of work statuses to ensure timely leave processing, benefits invoicing, health care coverage maintenance, etc. as applicable.
10. Grant reserve concurrence/approval for total incurred amounts of $50-75,000.
11. Grant settlement authority up to $30,000 (lump sum payment).
12. Coordinate closely with NDCP’s Leave Specialist to ensure the timely notification of FMLA and ADA-related documentation and follow-up is maintained.
13. Assist the Workers Compensation Sr. Specialist/Supervisor/Manager with monthly claim review meetings with operations leaders and applicable HR business partners. Maintain spreadsheet with current status for all employees out of work or on modified duty assignments until full duty release and actual RTW.
14. Interprets, administers, and ensures compliance with state WC laws and regulations, as well as human resources policies and procedures.

Supervision Exercised

This position has no direct reports.

• Bachelor’s degree strongly preferred. High School Diploma required.
• Three – five years’ experience adjusting workers’ compensation lost time claims (including medical only for the same account) in an insurance company, third party administrator (TPA), or self-insured employer environment.
• Two years or more experience working in a human resources-related workers compensation, benefits and/or generalist role at the corporate level strongly preferred but not required.
• Proven ability to generate statistical reports in excel, word or other versions.
• Proven ability to succinctly provide verbal and written claim status updates (customized by the designated audience).

Knowledge and Skills

• Proficient in workers’ compensation claim reserving philosophies and practices.
• Proficient in workers’ compensation settlement evaluation and negotiation skills.
• Professional claim designation (e.g., AIS, CWCP, CLA, SCLA, CPCU, etc.) not required but a plus.
• Working knowledge of workers compensation-related state regulations, as well as general knowledge of FMLA and ADA laws and the application to workers compensation-related absences.
• Proficient in Microsoft Office software, particularly word and excel required, with technical aptitude to quickly pick up claims management systems (based on assigned TPA). ADP, etc.
• Ability to create meaningful analytical reports related to workers compensation claims and trends and communicate critical information to HR and operations leaders in a timely and effective manner.
• Strong self-initiative and the ability to effectively work independently.
• Exceptional organizational and follow-up skills, along with the ability to effectively prioritize work to complete assignments by established deadlines.
• Professional interpersonal skills and the ability to manage sensitive and confidential situations / materials in a legally compliant and appropriate manner.
• Ability to communicate professionally and effectively, both in writing and verbally, with all levels of employees / outside vendors.
• Ability to effectively multi-task.

Job tags

Salary