What are the responsibilities and job description for the Sr Risk Management Analyst - Workers Comp position at HMSHost?
Purpose : The Senior Risk Management Analyst is responsible for providing oversight to the company's Workers' Compensation claims in the US and Canada, ensuring timely and appropriate resolution through appropriate compensability determination, reserving, and settlement evaluation. This position acts as a liaison between Third-Party Administrators (TPAs) and Field Operations.
Essential Functions :
- Guides field management on ensuring accurate claim reporting, claim management and return-to-work procedures; provides field training on various aspects of safety and Workers Compensation compliance
- Monitors TPA expenses regarding assignment of outside claim investigators, nurse case management, physician reviews, Medicare / SCHIP Set-Asides
- Coordinates complex claim resolution with Legal, including claims that have an ADA, EEOC or FMLA component to the Worker's Compensation claim
- Provides oversight of third-party administrator by conducting quarterly claim reviews, audits, and other claim related projects
- Provides and manages oversight of the Company National Occupational Medial vendor
- Manages State Funded Workers' Compensation oversight regarding uploads to claim system, quarterly premium payments, and outside attorney assignment and expenses
- Identifies claim trends and recommends training programs, procedures, and actions to reduce claim costs
- Develops and maintains state required in-network physician panels
- Monitors 24 / 7 Nurse Triage program and encourages location participation
- Updates knowledge base on claim practices, case law, and industry claim trends
- Processes premium payments in US and Canada
- Handles OSHA complaints, investigations and formal response
- Manages and oversees safety audit for compliance
- Manages and oversees the Company Slip Resistant program
Reporting Relationship : The Senior Risk Management Analyst reports to the Senior Director of Risk Management.
Minimum Qualifications, Knowledge, Skills, and Work Environment :
In a technical role : Requires 3-5 years of technical claims experience with a carrier or TPA
A bachelor's degree in a program related to the functional area can count for 1 of the 3-year requirement
Training that leads to federal and state-specific Workers' Compensation regulations
Proficient in Microsoft Office and Claim Management Systems
Disclaimer :
All job requirements are subject to change to reflect the evolving position requirements or to reasonably accommodate individuals with disabilities. Some requirements may exclude individuals who pose a threat or risk to the health and safety of themselves or other employees. This job description in no way states or implies that these are the only duties to which will be required in this position. Employees will be required to follow other job-related duties as requested by their supervisor / manager (within guidelines and compliance with Federal and State Laws). Continued employment remains on an "at-will" basis.
Dufry, Hudson, and HMSHost are equal opportunity employers and do not discriminate in employment on the basis of race, color, religion, sex (including pregnancy and gender identity), national origin, political affiliation, sexual orientation, marital status, disability, genetic information, age, membership in an employee organization, retaliation, parental status, military service, or other non-merit factors.
