Workers' Compensation Claim Analyst II

Description

Basic Function   Workers’ Compensation Claim Analyst II is a point of contact for internal and external workers’ compensation related issues. This role serves as the lead within the WC Team. General duties for this level continue in providing oversight of workers’ compensation claims management, data collection/input/distribution, report preparations and compliance with the Company’s Workers’ Compensation Policies and Procedures to franchises across jurisdictions. They will serve as a liaison between the franchises and the third party administrator by providing accurate, professional, and timely consultative customer services to the franchises regarding interpretation of the workers’ compensation information via phone, email or legal correspondence. 

This position will also include participating in program initiatives and special project coordination and implementation with WC Supervisor and Manager.

Responsibilities including monitoring and ensuring the WC email “QUE” is up to date and current. This includes requests to review reserves increases, settlement matters, wage requests etc. Ensuing regular mail for team is opened and addressed timely. Ensuring Voicemails left for the team in the queue are answered timely.

This person will lead and coordinate work comp training sessions as needed for franchises. They must be able to handle escalated matters independently, unless Management level is necessary to resolve. The overall objective of this position is to minimize the severity of workers’ compensation cost by providing effective communication, ongoing support, and training to the franchises.  

Typical Requirements:  Bachelor’s degree (preferred in business, accounting, and/or finance).  Customer service experience – 2-4 years (required)

In-depth knowledge with the insurance industry, workers’ compensation claims, legal and regulatory environment required.  

Licenses/Designations: Workers’ Compensation license or equivalent Property/ Casualty and/ or Experience in first hand claims adjusting.

This candidate must have the following skill set:

• Excellent written                  
• Excellent verbal  
• Ability to interpret and clarify information 
• Ability to listen 
• Analytical thinking
• Strong decision maker

This position requires integrity, confidentiality, good judgment and strong decision-making skills.

     Essential Functions

          1. Actively participate and lead team members in the following essential daily functions.

Interpret, communicate, and educate workers’ compensation best practices through pro-active and interactive telephone dialogue, email or legal correspondence on a daily basis. Assist WC Manager with higher level claims management that includes the interaction and collaboration with internal legal and human resources department.  

Analyze claims, provide direction to the TPA, consult with TPA and/or franchise with, but not limited to, legal matters and designated reserve authorities as requested and outlined in TPA Client Service Instructions. Handle escalated matters independently unless Management level is warranted to resolve. 

Also, managing the WC email QUE to ensure timely responses to reserve requests, settlement matters and wages etc. 

            Percent of Time __70____                           Frequency _____W_______

          2. Analyze claims impacting the upcoming modifier for selected franchises. Review all claims which fall in the              modifier for possible reduction of reserves or possible closure in order to create a positive impact on the                      upcoming modifier.

Serve as the lead with in-depth modifier training, with developers and franchises. Also, lead and train teammates when opportunities arise in the understanding of the modifier process.

            Percent of Time __20_____             Frequency ______W______

           3. Assist the Workers’ Compensation Manager and Broker in conducting and participating in quality claim                   reviews with the Third Party Administrator. Maintain and ensure TPA compliance with Express Employment                 Professionals Client Service Instructions and pro-active claim handling against Industry Best Practices.                       Actively participate in the communication of results/findings to specified parties, such as VP of Risk                             Management, Executive Team and/or franchises upon request.

            Percent of Time __5_____               Frequency ______O______

            4. Coordinate with Loss Control prior to site visits to franchise location to ensure work comp analysis is                        completed timely for the WC Team. Identify if a visit is needed to provide education and training on specific                  workers’ compensation needs. Must communicate, schedule and perform new franchise education calls.                    Monitor for and provide hands on training with new franchise upon notification of their first workers’                              compensation claim.

          Percent of Time __5_____               Frequency ______O______

          Decision-Making

80%: Most tasks require an understanding of corporate risk guidelines and established practices and procedures.  Most decisions are guided by set procedures and time frames for task completion.  

20%: On occasion, some special tasks are moderately difficult and involved, requiring adaptation and interpretation of established practices and procedures to cover problems and situations to which their application is not clearly defined.

           Supervision: Received - Given

This position directs and leads team members and is under the general direction of Supervisor of Workers’ Compensation to administrate and accomplish goals in designed areas.

           Accuracy, Accountability and Control

Errors could have serious adverse financial impact on company and/or franchise owners.

          Contacts: Internal - External

Internal – Work closely with the other entities of Risk Management Department, Work Comp Accounting, Legal, HR and the Assistance Center on a regular/daily basis.  Exchange information and documents with various departments at HQ as requested.

External - Franchise owners and staff, associates, third party administrator (including nurses and investigators), insurance broker, insurance carrier, medical providers, and attorneys. 

           Specialized Skill or Technical Knowledge

           Intermediate MS Office skills; (Word, Excel, & PowerPoint). 

Technical knowledge of workers’ compensation and holds an active Workers’ Compensation adjusters license is required for this position. Top tier customer service skills, phone etiquette, ability and comfort level talking with business owners and executives. 

Confidential Information

• Workers’ Compensation data, claim information- such as medical records, social security numbers, payroll, personnel records. 
• Details of legal proceedings and strategies to minimize the cost of Workers’ Compensation claims.
• Proprietary corporate and franchise business information

Working Conditions

Typical office environment, copier, and Microsoft Office software suite.

Occasional travel to franchise locations or conferences.

Special Assignments

Occasionally perform special assignments not related to assigned risk management areas of responsibilities but expected in a corporate environment.

Qualifications