Workers Compensation Claims Manager Jobs in Fremont, Iowa

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.

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.

Ability to attain all applicable state licenses within 30 days of hire and maintain appropriate continued education requirements

Notifies the Claim Manager/Supervisor of claims which require assignment to higher level Claims team members

Three years of claims support experience or related experience

Basic knowledge of insurance and claims processing

Strong knowledge of insurance and claims terminology

Good knowledge of computers, software, and applications

Negotiate and direct settlements under management's review

Effectively manage a caseload of loss time claims from numerous jurisdictions, including NY, PA, MA, NJ, MD, and TN.

A minimum of three years' experience required

Experience handling claims in NY, PA, MA, NJ, MD, or TN

Experience in handling lost time or litigated claims

Demonstration of strong organizational, problem solving, negotiation, and conflict resolution skills

Litigation management - Direct, manage, and control the litigation process.

Handles other duties and tasks as deemed appropriate by the Supervisor or Manager.

Initiate the referral to the SIU of cases with suspected fraud.

Aggressively pursue subrogation from culpable third parties, contributions on multiple defendant cases, and apportionment when there is pre-existing disability.

Review and approve all vocational rehabilitation plans.

Establish, monitor, and adjust monetary case reserves when warranted and in strict accordance with assigned authority levels.

Maintain knowledge of jurisdictional requirements and applicable case law for each State, including appropriate licensure and continuing education requirements.

Ensure all benefits are paid timely and in accordance with jurisdictional requirements.

Coordinate vendor utilization while considering claim cost containment techniques and outcomes, including but not limited to nurse case management, surveillance, etc.

Notify management of large loss exposure, denial, coverage disputes, subrogation potential, or other matters requiring escalation or collaboration.

A combination of education and experience in a TPA or brokerage environment will be considered

Ensure compliance of claims handling requirements pursuant to all state, legal, statutory and regulatory bodies.

Submits referrals to the Special Investigation, Subrogation, Corporate Office Coverage Counsel, Medical Management and Medical Review Units as appropriate

Audits TPA benefit calculations due and ensures they are paid appropriately

Manages claim recoveries including resolution of financial deviations and subrogation

Ensures TPA compliance with all state-specific and jurisdictional reporting requirements through all required communication channels and documents actions appropriately

Maintains continuing education credits and current licenses as required by jurisdiction

Assists with training less experienced team members

Bachelor’s Degree Preferred (Business Administration, Insurance or Risk Management) or equivalent combination of education, training, and experience

Provide oversight as needed to respective regional Workplace Health Team for day-to-day operations, project management, and claim escalations.

A background in risk management and/or workers’ compensation claims management with a large-scale manufacturer or distributor is preferred but not required

Generate quarterly reports to Workers’ Compensation Manager related to high-exposure events, injury trends, claim costs, and workers’ compensation metrics.

Coordinate with the Return-to-Work team for employees who are receiving disability benefits due to non-accommodation in their department

Ad-hoc reporting, data analysis, presentations and training as requested by the Workers’ Compensation Manager.

3+ years’ workers’ compensation case management experience or related field required

Maintains regular contact with all parties involved to facilitate communication and to provide medical and vocational management and coordination services.

Educates the employer on the tangible and intangible benefits of accommodating the injured worker to keep him in the work force.

Strong cost containment background, such as utilization review or managed care also useful

Well-developed verbal and written communication skills with strong attention to detail

Excellent organizational skills and ability to multi-task

Minimum of 2+ years of Utah lost time/disability work comp adjusting experience

Working knowledge of the Utah work comp medical network

Excellent oral and written communication skills

Experience supervising other adjusters is a plus, but not required.

Additional voluntary supplemental benefits including dental, vision, life insurance, disability, accident, critical illness, etc.

Sound understanding of proper reserving practices

Manage an assigned agency territory and book of business maintaining profitability and furthering the growth of the state of GA.

Promote and maintain collaborative relationships across departments to manage account activity.

A minimum of 5 years workers’ compensation underwriting experience in Georgia; multi-state underwriting experience is a plus.

Experience underwriting large and/or complex risks.

Strong sales & marketing skills. Successful track record of developing productive agency relationships.

Excellent communication skills; able to communicate the company’s message clearly and effectively during agency/client meetings & presentations.

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 people management skills, effective at coaching and motivating staff. Serves as a role model in building effective relationships

Manage according to established expense, reserve and settlement authority levels.

Bachelor's degree with related claims experience

Effectively and creatively utilizes all resources (systems, people, etc.) to manage daily operations

Possess advanced claims technical knowledge combined with the ability to teach

Supervisory experience preferred but not required

Experience: Clerical or customer service experience or equivalent combination of education and experience preferred

A diverse and comprehensive benefits offering including medical, dental vision, 401K, PTO and more

An assigned mentor and manager who will guide you on your career journey

Career development and promotional growth opportunities through increasing responsibilities

A diverse and comprehensive benefits package to take care of your mental, physical, financial and professional needs

Education & Licensing: High school diploma or GED required

Strong organizational and time-management skills.

Proficiency in computer programs, including Microsoft Office and claims management software.

Minimum of 1 year experience as a workers compensation claims adjuster.

License/state experience in the Southeast region.

Demonstrated knowledge of workers compensation laws and regulations.

Strong analytical and problem-solving skills.

Workers' Compensation Coordinator, Risk Management - UT System

Excellent communication skills with a variety of audiences at all levels of the University

A willingness to learn new skills

Duties and responsibilities of the Workers' Compensation Coordinator include, but are not limited to, the following:

Independently designs and conducts work comp training presentations to UT System supervisors upon request, via in-person, or zoom training sessions.

Proficiency in Microsoft Office programs, including Excel, Word, Outlook, and PowerPoint

Disability case management experience preferred.

Certified Case Manager (CCM), Certified Disability Management Specialist (CDMS), Clinical Research Counselor (CRC), or Certified Rehab Registered Nurse (CRRN) preferred.

Utilize internal Claim Platform Systems to manage all claim activities on a timely basis.

General Insurance Contract Knowledge: Ability to understand policies and contracts, as they apply to policy conditions.

Medical knowledge: Thorough knowledge of the nature and extent of injuries, periods of disability, and treatment needed.

Coordinate with medical providers to ensure the injured employee is actively participating in a viable treatment plan.

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

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.