Claims Adjuster

Summary of Position:

Administers and maintains Summa’s self-insured workers’ compensation program, and leaves of absences including Family Medical Leave Act (FMLA), according to established policies, guidelines, and governmental regulations. Independently reviews and approves/denies claims for compensation and medical expenses. Represents Summa at all levels of hearings.

Minimum Qualifications:

1. Formal Education Required:

a. Bachelor’s degree in business or related field of study or equivalent in training and experience.

2. Experience & Training Required:

a. Four (4) years workers’ compensation experience

b. Two (2) years of experience with direct responsibility for claims management process of self-insured business including experience with State hearing process and experience with FMLA within a sophisticated disability management setting.

3. Other Skills, Competencies and Qualifications:

a. Excellent analytical, written and verbal communication skills.

b. Ability to develop and maintain working relationships with managers, co-workers, employees, union, physicians, hospital departments, state agencies and external agencies participating in management or review of claims and claimant’s attorneys.

c. Ability to maintain confidentiality of employee records.

d. Ability to perform in work-team environment.

e. Maintains working knowledge of claims hearing process.

f. Maintains working knowledge of current case law affecting workers’ compensation.

g. Maintains working knowledge of current case law/regulations affecting FMLA.

h. Possesses technical/PC skills sufficient to have working knowledge of multiple software packages, i.e. Compensate, Peoplesoft, Outlook, Word, Access, Kronos, etc.

i. Ability to effectively interact with populations of patients/customers with an understanding of their needs for self-respect and dignity.

4. Level of Physical Demands:

a. Sedentary: Exerts up to ten pounds of force occasionally and/or a negligible amount of force frequently.

7. Essential Functions:

The following job specific requirements should discuss the essential duties and responsibilities required of the position. They should not replicate those duties and responsibilities discussed above.

1) Workers’ Compensation

Administers self-insured WC Program for the system and correspondence for processing. Responsible for compliance with SI-40 reporting, Self-Insurance application, and payment of assessment fees; coordinates BWC audits.

2) Workers’ Compensation Claims Management

Develops a strategy of aggressive claims management to maximize cost-savings. Requires correspondence and coordination with external legal counsel, physicians and vendors. Negotiates permanent-partial disability awards with injured workers’ attorney.

3) Family Medical Leave Act/Leave of Absence

Reviews and verifies claims for eligibility; obtains medical certification and clarification, when appropriate; monitors leave for return to work, exhaustion of paid time, and exhaustion of FMLA. Aggressive manages claims to minimize non-productive hours. Coordinates with Employee Benefits regarding payment of benefits and removal from payroll. Corresponds with employee and department concerning leave status.

4) OSHA

Per federal guidelines, administers OSHA-300 Log, prepare monthly and annual OSHA log for Summa entities and the Safety Department followed by periodic review with Safety Department.

5) Reporting Requirements

Develops and/or analyzes software systems to enhance or replace current systems; develops tracking and reporting systems to effectively manage workers’ compensation costs and claims.

6) Safety and Ergonomics

Participates in committees in promoting health and productivity in the organization. Researches and recommends best practices, analyzes workers’ compensation data to identify trends and opportunities for program improvement.

Job Type: Full-time

Pay: $30.60 - $45.90 per hour

Benefits:

• 401(k)
• Dental insurance
• Health insurance
• Paid time off
• Vision insurance

Schedule:

• 8 hour shift

Work Location: Hybrid remote in Akron, OH 44310

Salary : $31 - $46