Workers Compensation Claims Review Specialist III

Aerotek - Tempe, AZ (30+ days ago)

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Aerotek has an immediate opening for a Workers' Compensation Claims Review Specialist III at the corporate office in Tempe, AZ.

Job Summary: Reporting to Workers’ Compensation Compliance Supervisor and Workers’ Compensation Compliance Manager, the Claims Review Specialist III will assist in the monitoring and administering of Aerotek’s workers compensation program to ensure the maximum cost containment. Seek to ensure that Third Party Administrator (TPA) is managing claims efficiently.

Essential Functions:
  • Conducts and properly document all incident /accident investigations into our RIMIS. Ensures the TPA thoroughly and properly investigates all initial claims. Monitor to ensure that TPA follows appropriate state workers compensation laws and defenses
  • Within the scope of authority, reviews and authorizes workers’ compensation settlement offers to be made by the TPA
  • Effectively monitors medical and disability claim authorizations and payments to ensure their appropriate and accurate
  • Reviews costs associated with all claims handling and develops strategies to improve performance
  • Works with TPA to move claims toward closure
  • Partners with Safety, Human Resources and Corporate Legal to drive claims management.
  • Makes appropriate referrals to outside vendors such as defense attorneys, nurse case managers and investigator.
  • Coordinates the employee’s release to transitional duty with the Return to Work Specialist and the Field Office;
  • Obtains evidence in contested and/or litigated claims to assist outside attorneys to defend claim and to prepare for trial.
  • Ensure timely resolution of legacy claims
  • Collect OSHA data and update OSHA field
  • Initiates subrogation where appropriate with management’s authorization
  • Prepares for and attends Claim Review Conference with TPA to evaluate individual cases; reviews, and adjusts financial reserves of claims; negotiates with TPA the settlement of claims within established authority and work together to develop detailed and doable Plans of Actions
  • Review reserves and provide authorization to TPA, where appropriate within authority
  • Reviews performance of external vendors in the areas of claims administration, manages litigation and make recommendation to Workers’ Compensation Compliance Supervisor for adjustments
  • Monitors and reviews workers’ compensation claims and the claims processing; identifies claims management trends and inefficiencies and make recommendation as needed
  • Participates in developing strategies to reduce claims frequency and severity
  • Establishes and maintains a file and diary on all open claims
  • Assists in the ongoing training of the Claims Review Specialist I and II
  • Develops and conducts training to field offices regarding workers’ compensation issues and process
  • Attends training sessions, conferences and workshops to keep abreast of current practices, programs and legal issues for the purpose of conveying and/or gathering information required to perform functions
  • Authority level for settlements up to $200,000
  • Authority level for reserves up to $250,000
Minimum Education/Abilities/Skills:
  • Bachelor’s Degree from an accredited college or university with major course work in Business, Risk
Management or related field and:
  • Six (6) years of professional experience investigating and resolving employee or third-party Workers'
Compensation claims as an adjuster, examiner, or equivalent or;
  • High School Diploma and possession of industry related certification and/or designation of Associate In Claims
(AIC) and/or Associate in Risk Management (ARM) or Charted Property Casualty Underwriter (CPCU) and eight
(8) years’ work experience in risk management or workers compensation adjusting or
  • Minimum of three years of experience performing duties equivalent to a Claims Review Specialist II with
Aerotek investigating and resolving Workers' Compensation claims if. Prior work experience in adjusting claims
in insurance environment can be substituted for experience working at Aerotek;
  • Received an Exceed on most recent Performance Evaluation as a Claims Review Specialist II
  • Excellent work history and attendance records
  • Knowledge of applicable federal and state law pertaining to workers compensation
  • Ability to learn TPA system and generate requested reports
Special Requirements:
  • Must have at least five (5) years’ experience in workers compensation claims management