Workers Compensation Claims Manager Jobs

Five (5) years of claims management experience or equivalent combination of education and experience required

Coordinates vendor referrals for additional investigation and/or litigation management.

Refers cases as appropriate to supervisor and management.

SkillsQualifications: Bachelor's degree from an accredited college or university preferred

DescriptionDescription:Analyze complex or technically difficult workers' compensation claims to determine benefits due.

Manages the litigation process; ensures timely and cost effective claims resolution.

Experience applying laws, rules, regulations, policies, and procedures when reviewing claims for benefits

Experience adjudicating highly complex cases for benefits based on evidence.

Experience reviewing reconsideration requests or appeals for benefits.

Requires a probationary period if the requirement has not been met.

Experience making and issuing final decisions that affirm or remand cases for further development

Reviews claimant requests for reconsideration of final decisions with delegated authority to finalize or modify decisions of the initial claims examiner.

Provide WC claims’ management education and WC regulatory updates to local business units.

Bachelor’s degree in Risk Management, Finance or Nursing background preferred

Ability to effectively work and collaborate with people with a wide range of skills, experience, cultures, and capabilities

Other duties as directed by management

Minimum seven (7) years of experience managing WC claims

WC technical knowledge and WC case law in multiple jurisdictions from Ohio to California

C (Download PDF reader)lick here to view Minimum Qualification Specification (Download PDF reader)

Click here to view Minimum Qualification Specification (Download PDF reader)

o qualify, you must meet all of the following requirements:

Professional Trainee II: SR-18, Salary $4,339 per month

Professional Trainee I: SR-16, Salary $4,011 per month

Consideration may be given to lower levels:

Communicate with manager on claims above authority granted.

Participate in OR's Managed Care Excellence Group as requested.

Ensure TPA compliance with our best claim practices.

Provide direction to TPA as needed.

Act as liaison between insureds and TPA as needed.

Review/ approve reserves on assigned claims.

Provide WC claims’ management education and WC regulatory updates to local business units.

Bachelor’s degree in Risk Management, Finance or Nursing background preferred

Ability to effectively work and collaborate with people with a wide range of skills, experience, cultures, and capabilities

Other duties as directed by management

Minimum seven (7) years of experience managing WC claims

WC technical knowledge and WC case law in multiple jurisdictions from Ohio to California

Leadership ability and demonstrated time management skills to delegate work appropriately and organize resources effectively.

Manages an inventory of workers compensation claims to evaluate compensability/liability.

Excellent interpersonal skills to communicate and negotiate with customers and conduct investigations required.

Establishes action plan based on case facts, best practices, protocols, regulatory issues and available resources.

Plans and conducts investigations of claims to confirm coverage and compensability.

Performs other duties as assigned.

If you are relying on your education to meet qualification requirements:

Prepares reports and provides data advising management of new trends in the hearing program.

Requires a probationary period if the requirement has not been met.

Drafting and/or signing final decisions or briefs to claimants who have applied for compensation benefits.

Analyze and interpret legal issue(s) to determine entitlement to workers' compensation benefits under federal laws.

You will be evaluated for this job based on how well you meet the qualifications above.

Manage existing workloads effectively to achieve quality and quantity production goals while providing superior customer service.

Control file-related expenses through efficient utilization and monitoring of "outside" vendors.

Inform other departments of positive/negative conditions noted during investigations which may impact company results.

Manage all aspects of claims to resolution in accordance with jurisdictional requirements

Obtain appropriate state adjuster certification and continuing education credits

Establish appropriate claim reserve and manage reserve adequacy throughout life of claim

Negotiate skillfully in difficult situations to win concessions without damaging relationships

Minimum 3 years progressive work experience in administrative role

Bachelor's Degree in relevant field or equivalent work experience

Education & Licensing: 5-7 years of claims management experience or equivalent combination of education and experience required.

Apply your knowledge and experience to adjudicate complex customer claims in the context of an energetic culture.

Compiles reviews and analyzes management reports and takes appropriate action.

A diverse and comprehensive benefits offering including medical, dental vision, 401K on day one

Access diverse and comprehensive benefits to take care of your mental, physical, financial and professional needs.

Performs quality review on claims in compliance with audit requirements, service contract requirements, and quality standards.

Strong leadership and team management skills, with a focus on fostering a collaborative and supportive work environment.

Oversee the management of LOA and WC cases, ensuring accurate documentation, timely communication with employees, and proper coordination with relevant stakeholders.

In-depth understanding of technical applications in leave management and workers' compensation programs

Conducts training sessions for managers, supervisors, and employees on LOA and workers' compensation policies and procedures.

At least 2 years’ experience leading and managing a team of at least 1 direct report.

Excellent critical thinking, problem-solving, and decision-making abilities.

Process payment of medical bills and invoices, meeting all statutory timeliness requirements

Minimum of one year of progressive office administration experience

Knowledge of workers’ compensation terminology preferred

Communicate with injured workers and service providers to facilitate claims administration

Provide injured workers with information about the workers’ compensation process

Handle multiple priorities simultaneously and effectively prioritize tasks to meet deadlines

Stay abreast of changes in compliance procedures and identify and communicate compliance process enhancement opportunities to management

Cultivate and maintain relationships with internal and external customers

Gather, analyze, and distribute compliance information to satisfy needs of business partners, and to facilitate appropriate outcomes

Complete assigned daily compliance support activities timely and accurately

Contribute assistance that enhances and enables achievement of compliance objectives by demonstrating teamwork and collaboration to elevate partner and customer service

Look for ways to improve compliance with state and federal laws and regulations

Education & Licensing: 3+years of claims management experience or equivalent combination of education and experience required.

Apply your knowledge and experience to adjudicate complex customer claims in the context of an energetic culture.

A diverse and comprehensive benefits offering including medical, dental vision, 401K on day one.

Access diverse and comprehensive benefits to take care of your mental, physical, financial and professional needs.

Approves and processes assigned claims, determines benefits due, and administers action plan pursuant to the claim or client contract.

Professional certification as applicable to line of business preferred.

Approves and processes assigned claims, determines benefits due and administers action plans pursuant to the claim or client contract.

Excellent oral and written communication, including presentation skills

Location: United States of America

Expiry Date: 15 September 2023

Develops and coordinates low-level workers' compensation claims' action plans for resolution, and return-to-work efforts, and approves claim payments.

Administers subrogation of claims and negotiates settlements.

Prepares reports and provides data advising management of new trends in the hearing program.

Requires a probationary period if the requirement has not been met.

Drafting and/or signing final decisions or briefs to claimants who have applied for compensation benefits.

Analyze and interpret legal issue(s) to determine entitlement to workers' compensation benefits under federal laws.

Serves as an Agency's independent authority and representative in reviewing claims and rendering appellate level decisions in classified claims.

Serves as the primary point of contact for Federal agencies on workers' compensation claims that contain classified information.

Approves and processes assigned claims, determines benefits due, and administers action plan pursuant to the claim or client contract.

Excellent oral and written communication, including presentation skills

Develops and coordinates low level workers compensation claims' action plans to resolution, return-to-work efforts, and approves claim payments.

Administers subrogation of claims and negotiates settlements.

Communicates claim action with claimant and client.

Ensures claim files are properly documented and claims coding is correct.

Strong multi-tasking, project management, and proactive problem-solving abilities.

Experience, education, and qualifications essential for success in this role, include:

Work with management and human resources staff to complete assigned compensation project work.

Location: In this US-based position your location will be remote in the Pacific, Mountain, or Central time zone.

Bachelor’s degree in a business-related discipline and/or a minimum of 5 years of business experience preferred.

Professional level understanding and demonstrated experience applying compensation theory and practice.

Education: Undergraduate studies in business administration or related field preferred and/or relevant Workers’ Compensation experience.

Other criteria, including leadership skills, competencies and experiences may take precedence.

Registered Nurse (RN) licensure required; Successful completion of required claims certification schools/courses. State licensing where required.

Three or more years of clinical experience required, medical coding or medical billing preferred.

Strong data analysis skills to determine medical bill rule design.

Delivers a positive customer service experience to all internal, external, current and prospective Nationwide customers.