Claims Review Specialist II

Aerotek - Tempe, AZ (5 months ago)

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Aerotek has an immediate opening for a Workers Compensation Specialist II at the corporate office in Tempe, AZ.

Job Summary: Reporting to the Workers Compensation Compliance Supervisor and Workers Compensation Compliance Manager, the Claims Review Specialist II 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 system. Ensures the TPA thoroughly and properly investigates all initial claims. Monitor to ensure that TPA follows appropriate state workers compensation laws and defenses
  • Authorizes investigation of suspicious cases
  • Within the scope of authority, reviews and authorizes worker’s 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.
  • 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
  • Evaluates Reserves to make adjustments with TPA, where appropriate within authority
  • Conducts bi-annual audits to ensure TPA is meeting their best practices requirements
  • 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; indentifies 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
  • Participates in communicating claims trends to Regional Safety Manager.
  • Assists in the ongoing training of the Claims Review Specialist I.
  • 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
Supervisory or Management Responsibilities:
  • N/A
Minimum Education/Abilities/Skills:
High School Diploma and 4 years work experience in insurance, workers compensation claim management or risk management or
Associate in Arts/Science and 3 years experience in workers compensation, or risk management or related field
Bachelor’s Degree with 2 years work experience in insurance, workers compensation claims management or risk management
Two years of experience performing duties equivalent to a Claims Review Specialist I with Aerotek investigating and resolving Workers' Compensation claims
Completion of the Crawford Workers Compensation Certificate
Excellent work history and attendance records
Knowledge of applicable federal and state law pertaining to workers compensation
Knowledge of the workers compensation claims and settlement process
Ability to learn TPA system & generate requested reports