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Claims Specialist

Company: Aston Carter
Location: Tempe
Posted on: June 21, 2022

Job Description:

Aston Carter has an immediate opening for a Workers Compensation Claims Review Specialist at the corporate office in Tempe, AZ.*This position will sit on-site at our Hanover, MD or Tempe, AZ corporate office* Scope of Position:Reporting to the Workers Compensation Compliance Supervisor and Workers Compensation Compliance Manager, the Claims Review Specialist will assist in the monitoring and administering of the worker's compensation program to ensure the maximum cost containment. Seek to ensure that Third Party Administrator (TPA) is managing claims efficiently.Essential Functions of the Claims Review Specialist: --- 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 --- 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 developing 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 --- Initiate 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 --- Conducts bi-annual audits to ensure TPA is meeting their best practices requirements --- 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 --- Participates in communicating claims trends to Regional Safety Manager --- Working with Compliance Supervisor to develop and conduct 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 $70,000 --- Authority level for reserves up to $80,000Qualifications:--- 2-5 years Workers' Compensation Claims Examiner or Adjuster experience--- Proficient in Microsoft Office (Excel and Word a must)--- Strong organizational and analytical abilities--- Strong communication skills and work ethic--- Goal driven with problem solving skills--- Ability to work independently and as a team player

Keywords: Aston Carter, Tempe , Claims Specialist, Other , Tempe, Arizona

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