Workers Compensation Resume Samples

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Guide the recruiter to the conclusion that you are the best candidate for the workers compensation job. It’s actually very simple. Tailor your resume by picking relevant responsibilities from the examples below and then add your accomplishments. This way, you can position yourself in the best way to get hired.

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Z Jacobs

Zoey

Jacobs

228 Hagenes Parkways

Houston

+1 (555) 661 0198

228 Hagenes Parkways

Houston

Phone

p +1 (555) 661 0198

Experience Experience

Los Angeles, CA

Workers Compensation Claims Supervisor

Los Angeles, CA

Kautzer-Weber

Los Angeles, CA

Workers Compensation Claims Supervisor

Supervision of claims staff including staff hiring, training, coaching, counseling and evaluating performance
Maintains knowledge of new and existing regulations, case law and court decisions, which could affect claims handling procedures
Completes regular quality audits of staffs work, records results and counsels staff to bring work to or above standards
Manages personnel administration including employee evaluations and salary administration
Prepares regular periodic reports and monitors system reports to ensure adherence to corporate and regulatory standards
Reviews findings with manager to jointly develop a plan for corrective action.
Defines team goals and communicates those goals to assigned staff. Motivates people to perform at the highest level

Phoenix, AZ

Manager Workers Compensation

Phoenix, AZ

Harber-Emmerich

Phoenix, AZ

Manager Workers Compensation

Extensive working knowledge of the QLD and NSW Coal Mining Workers Compensation legislation
Tertiary qualifications (or working towards) in relevant discipline (eg OT, Physio, RC, OHS)
Technically competent in Workers Compensation Case Management including complex claims, disputes, Regulatory matters, common law and litigated claims
Passion for safety as a way of life essential
Determines whether a claim is work-related and if a claim should be investigated
Monitors and manages the performances of the third party administrator (TPA), WC actuaries, consultants, outside WC attorneys and subcontractors, such as IME providers, networks, surveillance, and nurse case managers. Identifies and makes recommendations to resolve problems/areas of concern
Develops and delivers training/support to managers regarding incident and injury reporting. . Works with loss prevention staff to develop and implement Workers’ Compensation (WC) policies and initiatives designed to reduce claim frequency and severity

present

Detroit, MI

Workers Compensation Claims Manager

Detroit, MI

Schowalter LLC

present

Detroit, MI

Workers Compensation Claims Manager

present

Evaluate and approve / deny adjuster requests to increase reserves and provide settlement authority
Respond to all claim questions from internal clients, including but not limited to: Operations Managers, Legal Dept, Human Resources Dept, Safety and others
Respond to all questions and requests for assistance / documentation as concerns the claim investigation, analysis & defense strategy
Maintain productive working relationships and communications with all claim service providers and insurers on all aspects of the Sodexo claim program
Be the knowledge leader and subject matter expert of the fundamental underpinnings of workers compensation laws in the jurisdictions assigned
Prepare and present the key claim concepts, initiatives and fundamentals of effective claim management to educate line managers and division executives, as requested
Lead the Claim Review Conferences to focus on claim closures, reserving accuracy and direct strategy on challenging claims

Education Education

Bachelor’s Degree in Business

University of Washington

Bachelor’s Degree in Business

Skills Skills

Solid working knowledge of applicable state claim laws, rules and regulations
Extensive knowledge of utilization of Risk Management Information Systems
Extensive working knowledge of the QLD and NSW Coal Mining Workers Compensation legislation
Excellent persuasion and interactive skills in addressing interdepartmental Workers’ Compensation issues
Extensive knowledge of hearing and trial process and procedures
Acute financial analytical skills, including working knowledge of present value analysis
Extensive knowledge of legal and medical terminology
Working knowledge of regulatory agencies; OSHA, Health Department, police agencies, etc
Ability to work with retail and manufacturing management on Workers’ Compensation issues
Broad organizational skills, including the development of workflow and reengineering analysis

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15 Workers Compensation resume templates

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Senior Workers Compensation Analyst Resume Examples & Samples

Coordinate with HR that applicable work/comp information is being conveyed to new employees
Confirm that written protocols for handling injuries are at each site and location, with correct contact numbers
Confirm the contact information for emergency rooms & doctors for locations to send injured workers
Remain up to date on current workers’ compensation laws
On-call for all claim emergencies

Risk & Workers Compensation Analyst Resume Examples & Samples

Manages the day–to-day coordination of workers compensation claims including claim reporting and processing, research, and liaison with claimants, Human Resources, company management, the TPA, state agencies, unions and other third parties
Tracks and processes department expenses, invoices and other transactions
Assists with policy management and the collection/compilation of renewal data
Responds to risk and insurance service requests from business units and third parties

Claims Coordinator Workers Compensation & Disability Resume Examples & Samples

Coordinates daily activity and interaction between departments, TPA and vendors regarding all workers’ compensation and disability claims matters
Coordinates information for TPA’s determination of compensability of injuries and payments of temporary disability, permanent disability, medical, legal, investigation and other costs under workers’ compensation laws; and assists TPA with the determination of eligibility for industrial disability claims for employees
Counsels injured/disabled employees on workers’ compensation and disability coverage for long/short term disability; advise managers, supervisors and department liaisons regarding disability procedures, laws, regulations, and disability management
Obtains medical restrictions
Prepares forms, documents, correspondence, and other materials; provides orientation, counseling, training and other assistance to department representatives regarding program administration, policies and procedures related to workers’ compensation and disability claims
Maintains thorough and confidential records, logs, and databases; facilitates timely and accurate communication of information and materials that complies with applicable timelines and program regulations
Monitors and analyzes services for effectiveness and customer satisfaction; recommends corrective action regarding service delivery and administrative problems

Workers Compensation Associate Resume Examples & Samples

2+ years of Ohio Workers’ Compensation Defense experience is a MUST
Experience and comfortable handling a high volume practice
Licensed in Ohio

Workers Compensation Claims Analyst Resume Examples & Samples

6+ years' insurance carrier experience handling multi-state WC claims including, CA, TX, FL, IL, NY
2+ years' experience handling litigated claims and claims with damages in excess of $250,000
Intermediate level of active WC claims handling from cradle to grave with experience handling claims for commercial building technicians and maintenance staff
Intermediate level of experience with Return-to-Work programs, Nurse Case Managers, and pain medication management
Experience with Microsoft Office or similar application
Proven ability to manage financial matters and confidential information in an honest and moral manner
Accurate and convincing oral and written communication
Ability to meet short deadlines
Ability to handle simultaneous multiple tasks with minimal supervision
Ability to achieve targets within specified timelines

Risk & Workers Compensation Analyst Resume Examples & Samples

Minimum 5 years experience in a large, multi-location corporation, with at least 2 years experience in a Risk Management department
Experienced user of Microsoft Excel, Word, Outlook, and PowerPoint required
Proficiency in commonly used claims information data base systems a plus
Experience in entertainment, sports or other event businesses preferred

Workers Compensation Administrator Resume Examples & Samples

Oversees programming and execution of worker's comp claims
Monitors compliance with assigned jursidictions and all Self Insured filings, premiums and requirements
Ensures compliance with escalation criteria
Proficient in the use of word processing, database and internet programs
Ability to read, analyze, and interpret state worker's compensation regulations

Workers Compensation Associate Resume Examples & Samples

This attorney would work directly with the partner leading the workers’ compensation practice
Compensation is extremely competitive and there is negotiation potential for candidates with formal workers’ compensation experience
Virginia bar is required, DC bar is a plus
The ideal candidate will be able to work independently and be proactive in handling matters
Great opportunity to quickly get first-chair experience

Workers Compensation Associate Resume Examples & Samples

Extensive knowledge of California applicable statutes and application of such law
Handling of case from inception to trial
Ability to negotiate and have comprehensive understanding of all relevant law, both plaintiff and defense
Ability to write and argue motions without supervision
Requires the use of independent judgment, research, litigation and analytical skills
Prior experience in this practice area required
Prior firm experience
Licensed to practice law in California

Workers Compensation Claims Assistant Resume Examples & Samples

Demonstrated ability to work with confidential information
Demonstrated strong Guest Service skills
Proven knowledge and understanding of Walt Disney World policies and procedures
Demonstrated verbal and written communication skills, as well as telephone etiquette skills
Demonstrated strong organizational skills with attention to detail and accuracy
Demonstrated strong time management skills and ability to work with multiple deadlines
Demonstrated strong partnering skills
Demonstrated problem solving skills, as well as continuous improvement process skills
Demonstrated ability to use good judgment with a high degree of integrity
Active Florida Resident All-lines 6-20 License in good standing
Demonstrated understanding of Florida Workers’ Compensation statute
Demonstrated proficiency in CARS, HMS, eDocs, WorkBrain, SAP, Outlook
Bilingual – English and Spanish speaking and/or English and Haitian Creole speaking

Workers Compensation Resume Examples & Samples

Able to interpret hospital review fundamentals and guidelines for both inpatient and outpatient claims
Review and process facility bills including inpatient, outpatient, and out-of-state
Perform specialty bill review functions for PPO, liability and non- fee schedule claims
Communicate with facilities and/or clients as needed
Determines the appropriateness of a final reimbursement outcome by making the distinction between and knowing when to apply either Fee Schedule reduction, PPO reduction, Usual & Customary reduction, or Medicare reduction
Negotiate with providers after determining appropriate charges in order to convince providers to accept the recommendations
Ensure delivery of quality services and nurture positive employee/client relationships
One year workers' compensation fee schedule repricing experience required
Ability to comprehend and distinguish between facility review and medical review
Outstanding communicator, excellent written, verbal and interpersonal skills
Strong organizational skills along with the ability to prioritize
Ability to work on a team level

Workers Compensation Administrator Resume Examples & Samples

Critical employee relations and EEO support and related on-site training
Provides guidance and coaching to associates on employee relations issues
Administers and communicates FMLA regulations to associates
Assists in coordination of associate activities and is well acquainted with the workforce
Maintains knowledge of the new legal issues in the Federal and State HR arenas
Stays mindful of acceptable legal practices in the daily work place and diligently enforces policies in a manner consistent with the laws
Provides guidance and consultation to management in the resolution of staff complaints, performance coaching and counseling
Maintains overall awareness of EEO laws and regulations and responds to any issues or complaints of staff
Conducts investigations, prepares reports and makes recommendations as required
Participates in cross-functional teams responsible for the development and implementation of HR initiatives
Uses strong oral and written communication skills to explain complex regulations to all levels of staff
Provides HR support to other facilities as needed
Minimum of 4-6 years of progressively responsible experience in related HR function areas
Bachelor?s degree in a related field of study or an equivalent combination of education and experience from which comparable knowledge and abilities can be acquired
Strong knowledge of employee relations, compensation and benefits and FMLA regulations
Experience of working in a distribution environment is preferred
Ability and willingness to work 1 weekend every month to support a 7 days a week operations

Workers Compensation Representative Resume Examples & Samples

WCCP certification or equivalent
Must have successfully completed or has the ability to obtain professional certification of California Self-Insurance Administrator within 18 months
Must have designation as an Experienced Claims Adjuster, pursuant to California Code of Regulations, Title 10
Must comply with continuing education requirements for the Department of Insurance
Must be able to prioritize and perform complex and varied tasks in support of benefit provisions in line with California State and Regulatory Guidelines and the PG&E Job Standards
Comprehensive knowledge and experience with Permanent Disability Rating, AOE/COE Investigations, Supplemental Job Displacement Benefit (SJDB), Return to Work Benefits and WCAB Hearing Representation. Must have demonstrated ability and experience to take prompt and decisive action to interact and negotiate effectively with others. Have experience with written/recorded statements and Medical/Disability programs
Demonstrated proficiency in a variety of Claims Management computer programs and systems. Strong oral and written communication skills are required
Responsible for time sensitive decisions to meet regulatory mandates. Demonstrates the ability to analyze and resolve issues, set strategies, negotiate settlements. Develops action plans to provide timely WC benefits, resolve issues and settle WC claims. Negotiates settlements with injured workers within the settlement authority extended by management
Solicits information from injured workers, work locations, and medical facilities and claim history to determine WC Compensability
Coordinate utilization review and medical management to ensure medical treatment is appropriate and authorized as necessary
Evaluates the Company liability and establishes reserves based on the ultimate probable cost of the claim and in accordance with the state of California Self Insurance Plans regulations. Performs periodic re-evaluation of reserves to ensure adequate estimates of future liability are in accordance with state guidelines
Identifies and handles cases that may involve Return to Work issues, FEHA, FMLA or other HR, Employment related issues, with guidance from legal counsel or the WC Sr. WCR or WC WCS
Identifies potential fraud and initiates the investigation process. Manages potential 3rd party liability, and refers as appropriate
Facilitates Early Intervention and return to work efforts with field supervisors, medical providers and injured workers. Coordinates offers of modified, alternative or regular work
Communicates with internal external clients in a clear, concise manner, to appropriately administer benefits. Ensure all parties understand requirements and strategies. Acts as SME to resolve issues of a WC nature with client groups. May provide consulting services to various company lines of business, with regard to Workers’ Compensation in accordance with company policy, regulatory and state mandated requirements

Clinical Operations RN, Workers Compensation Resume Examples & Samples

Conduct telephonic outreach to patients, providers and / or insurance companies
Track and interpret physician Opioid Progress Reports as part of the Opioid Defense Manager program (ODM)
Maintain accurate, detailed notes in in case management system concerning claimant, adjustor and / or physician interactions
Interact with clients to update on claimant status and recommend other interventions to improve the medication management of the claimant
Upload returned Opioid Progress Reports to claims management system and ensure appropriate client handling and / or billing instructions are followed
Direct and assist Clinical Coordinators on administrative job responsibilities for operations within the ODM program as well as any guidance needed for the administrative operations of the Clinical Department products
Complete quality assurance checks on all Peer Reviews / CPRx reports; this includes sending to client, updating the formulary and any additional referral recommendations
Set up and completion of Urine Drug Screen referrals for the Clinical Services Department. This includes delivery of the completed report to the client, billing, updating of the formulary and any other necessary communication required
Clinical Nurse works with the staff pharmacist in completion of Compound Reviews, by recommending alternative medications from the approved formulary list compiled by the pharmacist. This includes oversight with the treating physician to change the medications as well as billing and sending completed compound reports to the clients
Provide oversight of the Nurse Case Manager module in TruCase or other case management systems including recommendations for future enhancements and notification of bugs. Assist with the development of letters and other materials utilized in the ODM program
Provide training for new hires for introduction to the Opioid Defense Manager Program
Run Clinical reports which include extracting data and assisting sales associates to interpret data to create client facing presentations
Develop, maintain and follow Policy and Procedures for the Clinical Services Department
Current and unrestricted RN license in the state of Ohio
Ability to navigate MS Office and a Windows based environment and the ability to create, edit, save, and send documents utilizing Microsoft Word, including the ability to navigate Outlook and conduct Internet searches
1 year or more of nursing experience providing direct patient care
Nursing Case Management experience
Pain Center / Management experience
Telephonic consulting experience
Experience with insurance claims or billing a plus

Workers Compensation Case Manager Resume Examples & Samples

3+ years of Nursing experience with Workers' Compensation cases and/or Rehabilitation Services
Solid assessment, clinical, and documentation skills
Able to multitask efficiently and effectively

Workers Compensation Program Coordinator Resume Examples & Samples

Coordinate patient’s entry into and through the health care system as related to a patient’s disability claims
Coordinate and Complete all paperwork and correspondence requirements related to patients’ medically-required absence from work or medically-required work restrictions (i.e. required absence from work post surgery or work restrictions post surgery)
Coordinate patient care services and serve as the patient advocate being available to both patient and physician during clinic sessions
Facilitate delivery of efficient patient care with coordination of services with the patient medical visit
Create clinic-specific policies, procedures, or workflows and adjust as state/payor regulations evolve
Under general direction, using knowledge of hospital and clinic policies, facilitate communication between the Employment and Social Security Administrations, DSHS, Dept of Vocational Rehabilitation’s CRC, and/or Worker’s Comp Case Managers with the Orthopaedic Surgeons promoting care to patients
Make initial contact and provide information to the patient or physician regarding the specific needs for any disability claims or medically-required absence from work
Act as primary liaison between the hospital, the patient and family, the physician, and outside worker’s comp, disability, and/or employment agencies in regard to coordination of each patient’s disability claim or medically-required absence from work
Interview patients to determine areas of concern and anticipated needs upon reappointments with physicians and outside agencies
Ensure the outcome of treatment recommendations for continued care is conveyed to outside consultants from the physicians
Complete the necessary forms and corresponding billing documentation
Collect and regularly report on statistics regarding volume of disability claims, types of disability claims, and corresponding revenue collected
Collect and regularly report on statistics regarding FMLA cases (i.e. medically-necessary absence from work due to surgery)
Budget Monitoring: correct L&I billing and reimbursement figures, monitoring patient spend down accounts
Act as a resource and technical consultant to physicians, RNs, and others on the care team regarding disability claim needs

Workers Compensation Resume Examples & Samples

Workers Compensation/Insurance Defense Litigation
Conduct extensive, complex legal research
Develop strategy, arguments and testimony
Prepare a variety of legal forms and documents such as pleadings, subpoenas, discovery requests and responses
2+ years of litigation experience, involving workers compensation/insurance defense
Experience using document management systems
J.D. from Top Tier law school
Exceptional organization and communication skills
Must be a member of the Florida Bar

L&I Workers Compensation Adjudicator Resume Examples & Samples

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Timely
Prepared
Active participant
Flexible
Open minded
Respectful
Professional
Courteous
Focused
Customer Centered
*Click HERE for suggested online typing test***

Workers Compensation Referral Coordinator Resume Examples & Samples

Complete referrals for all assigned clinics and accounts
Ensure that referrals are processed in a timely manner, preferably within 48 hours
Schedule STAT referrals for patient in order for swift transfer of patient to appointment
Process referrals according to client and insurance protocols
Submit Pre-certification and authorization requests as required
Proactively follow up with service providers to ensure patients are scheduled and document information in CCS notes queue
Communicate and document all referral information in CCS notes queue
Maintain current knowledge of W/C cases to ensure quality care within State mandated guidelines (Texas Workers' Compensation Act and Official Disability Guidelines (ODG))
Work closely with clinical Medical Directors and Regional Medical Directors to review and address potential inconsistencies within W/C cases
Troubleshoot incomplete referrals and coordinate with clinics for proper paperwork
Establish and maintain positive and productive relationships with clients, insurance companies, and CareNow clinics
Process requests for additional information from clients regarding their employees
Research and investigate claim discrepancies received from Adjusters and Nurse Case Managers
Correct demographic information in CCS if necessary, to maintain proper contact information for HO and clinical staff
Notify billing and marketing departments of needed changes to BCS client preference cards
Teamwork within W/C referrals department to ensure referrals are completed within preferred time constraint
Cross train throughout the Operations department to ensure sufficient coverage
Be a liaison between CareNow clinics and insurance companies
Respect and safeguard patient information and ensure complete compliance with all HIPAA regulations
Participate in Operations departmental meetings and company activities
Convey information to clients and clinics in clear, professional, and concise manner
High school diploma or equivalent. Some college preferred
Minimum of one year experience in healthcare required, preferably related to Texas Workers’ Compensation
Knowledge of medical terminology, CPT and ICD-9/ICD-10
Familiarity of Texas DWC Guidelines preferred, but not required
Strong analytical, data management, and computer software proficiency (e.g. EMR, CCS, BCS, word processing, Microsoft Outlook, etc.)
Self motivator and desire to exceed client and company expectations
Detail oriented, well organized with the ability to multitask
Must be able to work successfully as a team and individually
Proficiency in use of standard office equipment
Ability to read, understand, and maintain CareNow and HCA company policies and procedures

Workers Compensation Administrative Assistant Resume Examples & Samples

At least one year office work experience
Working knowledge of current business software such as Word and Excel
Experience operating multi line phone system

Workers Compensation Claims Technician Resume Examples & Samples

Set-up claims and update the loss to reflect actual circumstances
Determine the need for independent adjusters or independent medical examiners
Evaluate claim for potential fraud
Bachelors degree preferred, continuing insurance education desired
Thorough knowledge of insurance coverages, contracts & claims handling guidelines
Experience with disputed and/or litigated claims
Negotiation and settlement skills

Head of Middle Market Workers Compensation Line of Business Resume Examples & Samples

Execution of the overall Middle Market Workers Compensation Strategy: Is able to communicate that understanding to internal and external audiences, and is able to design and implement product, pricing, and service capabilities in support of that strategy
Establish and Communicate Underwriting Guidance: Research underwriting issues, establish and/or modify underwriting policy, guidelines, and appetite as well as prepare communications to Home Office management and/or the field for implementation of underwriting direction. Operate as Workers Compensation Subject Matter Expert providing expert advice on technical underwriting issues and/or referrals from the field
Lead Projects in Support of Workers Compensation Appetite Expansion: Support the development and lead the implementation of product, rating, pricing, and marketing solutions
Establish Communicate, and Monitor Rating and Pricing Strategy: Represent Middle Market Workers Compensation in working with Actuarial [and Product Development] to ensure the successful implementation of rate plans and pricing strategies
Support Workers Compensation Sales and Marketing Initiatives: Assist in the development of Workers Compensation internal and external marketing material demonstrating the value that The Hartford brings to agents and customers with our Middle Market Workers Compensation product offering. Support Underwriters across segments in their efforts to profitably grow the Workers Compensation business
Bachelor’s degree required; CPCU or other industry designation preferred
10+ years Commercial P&C insurance industry underwriting and product development experience with a background in Workers Compensation
Superior analytical & problem-solving skills, including the ability to

Workers Compensation Administrative Clerk Resume Examples & Samples

Supports the workers' compensation department by performing clerical duties including but not limited to copying, filing, faxing, scanning materials, receiving and distributing mail
Compiles and proofs reports
Inputs data into spreadsheets on PC and may perform simple calculations

Workers Compensation Resume Examples & Samples

Establish and maintain strong relationships with customers, build credibility and gain trust while operating with integrity at all times
Responsible for the investigation and file management of claims as well as assisting other claim professionals and our policy holders with multiple facets of the claims process
Serve as “the face of The Hartford” as we deliver on the insurance promise and make a difference in our customers’ lives
Achieve targeted performance goals to manage costs and support The Hartford’s industry-leading operational claims standards
Aggressively expand technical acumen to facilitate career advancement to high level positions within Claims upon paid training program completi
A passion for customer service
Demonstrated ability to effectively and persuasively communicate to a variety of customers
Comfort in making decisions after seeking out information (if you are looking for a processing type role, the ACR job is not for you)
Desire to advance your career and the willingness to do what it takes to achieve your goals
Willingness to learn, lead, be led, support your teammates, have fun and work hard in our Workers’ Compensation department

Workers Compensation Resume Examples & Samples

Providing medical expertise to MDO staff regarding authorizing of licensed providers; granting licenses to medical bureaus, medical centers, and laboratories
Assisting in the development of educational programs and trainings for WCB staff and external stakeholders on relevant topics including Medical Treatment and Impairment Guidelines, medical-legal issues, general medical conditions and other related topics
Providing medical expertise to the Chair and the Executive Staff, including Members of the Board as requested
Investigating complaints and incidents related to provider medical issues as assigned by Medical Director
Providing medical expertise and guidance to assist staff with difficult investigations, and directly investigating the more complex cases
Preparing clear and concise reports regarding findings and recommendations and discuss with the Medical Director to jointly develop a plan of action to address the recommendations

Senior Claims Rep-workers Compensation Resume Examples & Samples

Perform timely and thorough investigations in an effort to comply with all jurisdictional requirements and/or entitlements
Conducts an informed case analysis to address claim entitlements. Initiate reserve changes within assigned authority, makes recommendations to supervisor or manger where assigned authority is exceeded
Investigate, evaluate and resolve moderate level litigated files including all aspects of litigation management in accordance with the Claims Handling Guidelines
Maintain current case diary and ensure appropriate file documentation.Responsible for completion and/or submission of claim forms and reports as required by outside agencies
Investigate and evaluate recovery potential. Conduct timely and thorough subrogation investigation in accordance with company policy and procedures. Timely completion and referral of all claims involving recovery potential
Bachelor's degree (B. A.) preferred; 5+ years related WC claims experience Completion of insurance and/or claims courses preferred (IAA, AEI, CPCU)

Workers Compensation Claims Office Technician Resume Examples & Samples

Handle all paperwork, entering payroll, sending information to WC carriers, and diary into Stars claims system
Duties and tasks require independent analysis and independent judgment and reflect substantial variety and complexity
Performs complex office work such as document processing, record-keeping and report compilation
Assignments are broad in nature and usually require originality and ingenuity
Has a detailed knowledge of company and/or department procedures related to work performed
May serve as a resource to others in the resolution of complex problems and issues
This job often represents the top level of knowledge and specialization in the practices, procedures, and precedents of the department with a low level of supervision

Workers Compensation Administrative Assistant Resume Examples & Samples

Work Traits
Above average verbal and written communication skills, as well as, demonstrated competence in reading and basic mathematics
Able to maintain strict confidence regarding information contained in assigned work
Ability to professionally interact with all levels of branch personnel, as well as, clients, vendors and all other office visitors

Workers Compensation Telephonic Case Manager Resume Examples & Samples

(RN) with active CA license
Certification (CRRN, COHN, or CCM) preferred
Previous workers compensation, case management, experience required, with UR
Excellent communication and documentation skills needed

Supervisor Workers Compensation Claims Resume Examples & Samples

Advise, oversee, review, support, and train subordinates in all facets of Workers Compensation Claim handling/administration
Hold responsibility for assigned team’s management of all assigned workers’ compensation claims and required activities including not only the legal requirements, but also abiding within the organization’s best practices
Attend meetings/seminars of various related issues
Manage performance of team members
Interact with Human Resources, Legal, Safety, Loss Prevention, Albertsons’ Companies stores/distribution/warehouse and plant locations and personnel
Minimum of seven (7) years of experience in Workers’ Compensation claims
Minimum of four (4) years in supervisory capacity
Knowledge of the States Workers' Compensation system principles, statutes and judicial protocol. (Benefit calculation, compensability decision time line factors, and subrosa)
Knowledge of hearing and trial process and procedures
Knowledge of OSHA and state reporting requirements
Permanent disability systems and calculations Claims system coding and use
Strong interpersonal, negotiation and customer service skills
Capable of dealing with demanding customers
Must be able to effectively work in a team environment
Computer literate and knowledge of computer claim applications and Microsoft Office Suite preferred
Exceptional communication skills, including verbal and training
Extensive knowledge of audit requirements of the State of California and self-insured plans
Proven ability to understand and apply reserving practices
Proficient in math, reading, and writing skills
Experience in performance management

Complex Workers Compensation Director Resume Examples & Samples

Supervises the day-to-day claims activities for the unit by establishing priorities, scheduling and assigning work, adjusting schedules when necessary to meet completion dates, and assisting others with resolving complex problems while ensuring adherence to service and quality standards
Analyzes claims files prepared by claims staff, approves payments, and grants authority for settlements when appropriate. Acts as a technical expert and provides direction in various areas, such as compensability determination, investigation, coverage interpretation, claims reserves, and settlement. Refers issues above authority level to the next level of management
Uses the objective setting and performance evaluation processes to ensure employees understand the expectations, receive regular feedback, and are appropriately rewarded and developed. Deals decisively with performance and/or conduct issues using the performance management process
Ensures technical resources are engaged in assignments commensurate with their experience and job title and that direct reports receive a proper orientation, on-going technical training and development opportunities
Ensures compliance with related legislation, corporate policies, and programs. Monitors new and emerging exposures and coverage issues and makes recommendations to Regional HO Management regarding same. May periodically conduct desk audits
Assumes a leadership role with Regional/HO Management and other departments with new business and/or renewal presentations and periodic service calls
Demonstrates an exceptional ability to capture, extract and analyze data specific to existing and emerging risk. Can make and implement recommendations related to said analysis
Involved in the analysis and implementation of new and revised policies and procedures
Demonstrates a consistent high level of expertise in complex workers compensation issues and successfully imparts that expertise to direct reports
Leadership, technical and management skills to develop, manage and direct an office/unit operation of a highly experienced technical resources
Effective interpersonal skills to communicate operational procedures to field/unit staff, listen intently to concerns, and respond appropriately
Advanced knowledge of commercial lines claims; knowledge of department management practices, company operations and policies
Proficient in using various software programs (MS office) as normally obtained through a related bachelor's degree or equivalent
7-10 years of claims experience and significant experience managing complex and emerging risks
Exceptional written and verbal skills as well as exceptional data analysis skills required
Advanced insurance related designations and previous experience as a Claims Manager preferred
WC Claims Handling experience preferably CA
CA Complex Director Desk requires CA certification and a plus to have CA Independent adjuster license

Claims Manager Workers Compensation Resume Examples & Samples

Manage complex workers compensation claims to reduce costs and improve outcomes (80%)
Direct Third Party Administrator (TPA) claims examiners and outside counsel on litigated
Communicate policy related to accident reporting and managed care programs　
Monitor and evaluate the performance of outside counsel
Stay current with key changes in the legal and regulatory environment　
Manage workers compensation litigation budgets, evaluate adequacy of case reserves and advise on adjustments where necessary
Review and manage requests for investigations, discovery, and mediation/trial preparation
Establish and manage a regular cadence of claim review meetings with internal and external stakeholders to assist in managing claim developments and capturing high severity claims in early stages　
Authorize reserve and settlements on higher severity workers compensation claims　
Initiate audits and file reviews at TPA evaluating TPA performance nationwide　
Initiate and manage the Company’s return to work programs including collaboration with field operations and development of metrics that measure the success of the program. 　
Partner with business units and TPA to utilize all tools available for ‘Return To Work’ programs, nurse case management, etc. 　
Coordinate the assemble and execution of the discovery required by internal and external stakeholders　
Communicate with internal or external business professionals, attorneys and/or other third parties　
Possess or acquire knowledge about Company departments and functions including required claims functions　
Communicate with the Director, Claims Management to develop case strategy in effort to ensure the best possible results
Approves and/or pays bills as appropriate
Assist with general liability, auto liability, subrogation, property claims and other special claim management projects as necessary (5%)　
Develop and manage fleet management safety and claims programs for company car drivers (5%)　
Special projects assigned by Director, Claims Management and VP, Risk Management (10%)
Bachelor’s Degree; equivalent work experience may substitute　
Five (5) years of multi state claims handling experience with insurance carrier, third party administrator or insurance broker or experience in analyst role in similar operating environment
Analytical skills required in order to assemble and interpret claims, metrics and loss data, and produce regular reports showing status of cases and trends.　
Strong attention to detail, including regular follow up on action items.　
Team player with the ability to work in fast paced environment, handling multiple tasks and meeting deadlines.　
Proficient in software applications, including Excel and Word, as well as other databases, systems and software programs that are commonly utilized in the field. 　
Must interpret and analyze investigative, medical, legal and other reports
Excellent oral and written communications, including presentation skills.　
Excellent interpersonal and time management skills as well as a high degree of sound judgment, discretion, and initiative. 　
Professional Insurance or Claims Designation

Workers Compensation Claims Supervisor Resume Examples & Samples

Supervises, coordinates and monitors activities of a claims unit in order to obtain and ensure an accurate, quality product while maintaining high production standards and performance standards
Schedules, prioritizes, and distributes workflow of unit to ensure work is done in a timely fashion and all deadlines are met
Audits procedures and controls to ensure compliance with company and statutory requirements. Will provide statistical data to management to ensure adherence to company policies, procedures and state regulations
Provides technical assistance to members of staff and assist them with the disposition of claims with attorneys, insureds, and claimants
Reviews completed adjustments for corrections and authorizes payments when required
Establishes and adjusts claims reserves
Recognizes fraudulent claims activity that would be subject to SIU referral in accordance with company guidelines and subsequent referral to law enforcement or regulatory agencies
Reviews and implements claims audit recommendations on a continuous basis
Reviews consumer/agency complaints
Maintains a direct diary on serious claims and/or litigated claims and an override diary on other selected claims
3+ years supervisory experience of technical level staff preferred

Reinsurance Claim Manager Workers Compensation Resume Examples & Samples

Direct handling of Workers Compensation claims under assumed reinsurance agreements including understanding the reinsurance agreements and reviewing new and existing claims to verify reinsurance coverage, evaluate exposure, properly set reserves and consider and authorize claim payments
Conducting claim reviews at client offices and communicating results to stakeholders in a clear, comprehensive and meaningful way
Identifying, analyzing and reporting on claim trends
Leading a reinsurance Workers Compensation team on all claim functions, ensuring achievement of exceptional results in claim management
Collaborating with your team of Account Managers with a focus on professional development, ensuring they have the skills necessary to provide exceptional service to our customers
Responding to business needs of Underwriters and Actuaries to ensure we are providing clients with an exceptional experience
A minimum of 5 years of progressive experience handling Workers Compensation reinsurance / insurance claims
Comprehensive knowledge of multi-state workers compensation statutes and relevant medical terminology with effective research skills in order to stay abreast of relevant industry developments
Proven hands-on experience managing complex claims with strong comprehension of claims best practices and experience with case analysis and setting reserves
Strong analytical skills, especially relating to reserve modeling and overall program performance, and sound judgment with the ability to take initiative and to work independently
2 + years hands-on management experience inclusive of coaching, staff development, expectation setting, accountability as a role model and setting a high bar for performance, engagement and commitment; ability to multi-task and lead
Evidenced leadership skills in building and refining effective working relationships through direction of claims staff and interaction with internal and external clients, evidencing professionalism and diplomacy in all situations
Excellent verbal and written communication skills in all interactions with clients and internal senior management, business leadership and business partners
A willingness to ask questions and explore new ideas. Eager to learn with a focus on continuously improving technical skills
Proficiency with Microsoft Office applications including Excel, Outlook and Word as well as proficiencies with claims management systems
A Bachelor’s degree is required. Industry designations including Chartered Property Casualty Underwriter [CPCU] or similar or a Juris Doctor [JD] are a plus
Travel is anticipated at approximately up to 20% of the time

Manager Workers Compensation Resume Examples & Samples

Develop and implement division Workers’ Compensation processes and procedures in compliance with corporate and company policies
Determine and delegate claims settlement and reserve authority
Provide technical support and education to the Department staff and other customers in the Division
Track, monitor and supervise special projects
Interact with Corporate Risk Management Accounting in administration of the program
5-10 years claims administration experience
5 years claims management experience
Current on continuing education units per Jurisdictional requirements for licensure
Extensive knowledge of legal and medical terminology
Extensive knowledge of hearing and trial process and procedures
Extensive communication skills, including speaking and training
Excellent persuasion and interactive skills in addressing interdepartmental Workers’ Compensation issues
Extensive knowledge of utilization of Risk Management Information Systems
Full understanding and application of reserving practices
Solid working knowledge of applicable state claim laws, rules and regulations
Working knowledge of regulatory agencies; OSHA, Health Department, police agencies, etc
Strong negotiating skills prior professional negotiation training preferred
Broad organizational skills, including the development of workflow and reengineering analysis
Acute financial analytical skills, including working knowledge of present value analysis
Ability to work with retail and manufacturing management on Workers’ Compensation issues
Demonstrated experience in teambuilding

Claims Handler, Workers Compensation Resume Examples & Samples

Establish and maintain effective business partner relationships with DHL division Business Partners (BPs), external customers, accounting, legal departments and other key stakeholders. Communicates with key stakeholders within IRM, including contract risk, legal, customer service, insurers, underwriters and loss adjusters within agreed authority
Provide clarification on claims dispositions, Workers Compensation claim guidance and allocations
Coordinate BP’s interaction, reports and claims calls with the goal of limited financial exposures on claims
Provide best in class Workers Compensation claims training and education to internal and external customers
Plan, recommend and implement process improvement initiatives in alignment with key stakeholders and according to IRM guidelines
Provide guidance to the multiple BP’s as the trusted advisor
Investigates Workers Compensation claims to determine the exposure to the business and negotiates/advises advanced claim settlements
Has the authority to formulate, affect, interpret, or implement polices pertaining to strategic claim resolution. Ensure accurate financial forecasting for the life of a claim
Makes financial decisions based upon structured guidelines, policies and procedures with binding authority. Roundtables claims with Third Party Administrator (TPA) and legal. Monitors the TPA and makes financial judgment decisions for claims
Read, interpret and provide guidance with customer contracts in regards to claim language, acting as the subject matter expert for our BPs. Ensures that required documentation (investigation, resolution strategy and resolution) is correct and attached to the system
Produces and analyzes Workers Compensation claim trending reporting, which will then be shared with management and used as consultative or expert advice on projects or to develop long term or short term business strategies. These reports are used to help determine department structures, along with staffing needs and requirements
Leverages extensive understanding of multiple BP’s claims handling functions and multiple claim exposure situations
Triage critical Workers Compensation claims and ensure the proper involvement by all claim professionals and Business Partners to achieve the best outcome for our employees/customers
Bachelor Degree (Preferred) or equivalent claims experience
5+ years of claims handling (Preferred)
Professional Certificate (AIC or ARM preferred)
Experience in Logistics (Preferred)
Experience working with a Risk Management Information System (Preferred)
Experience in analyzing, negotiating and strategizing claims (Required)
Knowledge of insurance programs with insurance deductibles
Excellent analytical, Microsoft Office, problem solving, decision making and organizational skills
Knowledge of life of claim handling processes
Knowledge on how to apply process improvements
Actively seeks growth and development opportunities
Understands claim contract language and insurance policy language

Workers Compensation Claims Manager Resume Examples & Samples

Evaluate and approve / deny adjuster requests to increase reserves and provide settlement authority
Respond to all claim questions from internal clients, including but not limited to: Operations Managers, Legal Dept, Human Resources Dept, Safety and others
Respond to all questions and requests for assistance / documentation as concerns the claim investigation, analysis & defense strategy
Maintain productive working relationships and communications with all claim service providers and insurers on all aspects of the Sodexo claim program
Be the knowledge leader and subject matter expert of the fundamental underpinnings of workers compensation laws in the jurisdictions assigned
Be familiar with internal administrative processes and procedures (e.g., employee wage statements, FMLA, ADA, CA 132a interaction with legal dept, location per claim charge, etc.) required to administer, pay, adjudicate and charge claims
Maintain and update the list of Sodexo-preferred attorneys and other vendors who may assist in our defense and resolution of litigated and non-litigated claims
Prepare and present the key claim concepts, initiatives and fundamentals of effective claim management to educate line managers and division executives, as requested
Oversee the Claim Audit Process to ensure TPA adherence to theirs and our established minimum claim handling standards
Lead the Claim Review Conferences to focus on claim closures, reserving accuracy and direct strategy on challenging claims
Be the primary Sodexo resource for coordinating and facilitating successful Return-to-Work outcomes in your States
Evaluate and coordinate decisions related to claim subrogation, when required
Evaluate and make decisions concerning adjusters who are to be selected to handle Sodexo claims, as well as communicate concerns regarding Branch Office performance
Contribute as a project participant or leader in programs / initiatives which mitigate the employer / employee cost and impact of claims
Analyze claim data and trends to support conclusions regarding ongoing management and programs that enhance claim mitigation techniques
Hands-on experience investigating, managing and / or resolving workers compensation claims
Insurance Institute of America’s INS, AIC, ARM and / or CPCU, while not required, is preferred
Minimum four (4) years’ experience in either or combined: TPA / Carrier Claims Adjusting, Claim Consultancy and/ or Corporate Risk Management
Prior experience in Finance, Accounting, Management or related field within a corporate environment, while not required, is preferred
Excellent written & verbal communication, presentation and project management skills
Excellent organization & self-motivational skills

Workers Compensation Service Representative Resume Examples & Samples

High school diploma required
Able to plan and organize activities and workload and respond to multiple demands
Work Traits

Assistant VP-workers Compensation Resume Examples & Samples

High school diploma
15 or more years related claim experience required
At least 8 years of increasing growth through the management ranks from supervisor to branch manager
Appropriately licensed and/or certified in all states in which claims are being handled
Knowledge of all team member related functions
Bachelor's degree

Workers Compensation Claims Technician Resume Examples & Samples

Secures essential facts from injured worker, employer and providers regarding workers' compensations through telephone or written reports. Verifies information from claimants, physicians, and medical providers to assess compensability and/or causal relation of medical treatment and make evaluations for cases with specific on-going medical management
Provides on-going medical and/or disability case management for assigned claims. Maintains contact with injured worker, provider and employer to ensure understanding of protocols and claims processing and/or to confirm return-to-work date or medical treatment
Continually assesses claim status to determine if problem cases or those exceeding protocols should be referred to Claims Service Team and/or would benefit from, MP RN review or other medical /claims resources. Refers case to MP RN if light duty potential is identified at any point or for issues involving medical treatment or dispute involving disability or based on exception reports and defined departmental protocols
Maintains accurate records and handles administrative responsibilities associated with processing and payment of claims. Records and updates status notes; documents results of contacts, relevant medical reports, and duration information per file posting standards including making appropriate medical information viewable to customers in Electronic Document Management (EDM). Generates form letters following set guidelines (i.e., letters to physicians projecting disability, letters confirming medical treatment and disability and letters outlining expected outcome to employers)
Authorizes payment of weekly benefits, medical payments and/or medical treatment
Recognizes potential subrogation cases, prepares cases for subrogation and refers these cases to the Subrogation Units
Effective analytical skills required to learn and apply basic policy/contract coverage and recognize questionable coverage/contract situations (which necessitate supervisory involvement) along with effective interpersonal skills to explain the facts and logic used to arrive at decisions in a way that the customer understands
Effective written skills to compose clear, succinct descriptions when posting files and drafting correspondence
Ability to learn when to make proper use of medical management resources, know when to use them and follow through with medical management information received
Bachelor’s degree or equivalent and 3-5 years of Workers’ Compensation claims experience

Workers Compensation Claims Coordinator Resume Examples & Samples

Coordinate and oversee claims management strategies on reserving, settlement and closure to bring claims to resolution
Communicate and go on-site as necessary to locations to assist with all internal claims management activities
Participate and manage quarterly claims reviews with the TPA for managed claims
Maintain an internal active diary system of claims that are being managed
Coordinate for team internal claims update to Risk Management as requested / required, such as an internal claims review
Develop and Monitor goals for claim mitigation within stores
Monitor claims reporting to third party administrator and report claims as required
Work with stores safety to help identify and reduce claim trends
Manage return to work with internal and external partners
Monitors and reports the effectiveness of third party claims administrators with regard to this position’s assigned case load
Responsible for legally mandated mailings
Act as an internal resource for Workers’ Compensation questions
Utilizes TPA RMIS system for claims management

Workers Compensation Claims Unit Manager Resume Examples & Samples

Maintain primary responsibility for settlement decisions up to individual authority
Assign, control and monitor staff investigations/dispositions to assure compliance with state laws/regulations and department policies and procedures
Monitor and approve benefit, claims and expense payments to assure reasonableness, accuracy and timeliness
Review unit transactions to assure proper procedure and prompt error corrections
Oversee and manage unit Service Call Program
Monitor and assess adequacy of reserves
Ensure that claims are investigated promptly and that adjusters are taking statements as necessary to determine liability/compensability
Ensure that adjusters evaluate damages and pay benefits as prescribed by law and/or Marriott policies and procedures
Ensure that adjusters secure necessary documentation to facilitate timely loss adjustment and maintain primary responsibility for settlement decisions up to individual authority
Ensure that adjusters complete and monitor timely WC payments/state filings
Ensure that adjusters monitor WC medical treatment with the goal of minimizing disability. Consult Occupational Health Services as necessary
Ensure that litigation cases are managed including controlling/directing outside attorneys, assisting in discovery/trial preparation and strategy
Ensure that adjusters evaluate claims for potential third party or subrogation recovery
Increased settlement authority beyond that of a Senior Adjuster
Minimum of 5 years’ claims adjusting experience
Ability to manage multiple priorities and projects simultaneously
Ability to acquire and maintain relationships with associates, customers (internal & external), vendors
Possess good technical knowledge of civil laws and state workers’ compensation statutes
Demonstrate ability to meet quality and production standards
Demonstrate leadership, teamwork and management skills
Provide technical knowledge and direction, including litigation case management training and support
Good communication skills (verbal, listening, writing), including the ability to deliver difficult messages to customers, claimants and/or peers
Good investigation skills
Ability to work well in a team, providing assistance to fellow associates and representing the mission of the unit, department or region
Possess a willingness to accept and respond to constructive criticism

Workers Compensation Claims Coordinator Resume Examples & Samples

High School diploma or GED equivalent; Associate Degree preferred
Strong customer service experience required
Experience in a Human Resources, Loss Prevention or Asset Protection position preferred
Experience with workers' compensation preferred

Workers Compensation Operations Manager Resume Examples & Samples

Manage Workers’ Compensation operations, including claims, medical management, processing and administration
Develop business plans and budgets
Represent Ford with both internal and external clients
Present ideas and concepts (orally and written) to senior management, and influence outcomes
Manage all technical and administrative functions for the entire program
Oversee responsibilities for all Workers’ Compensation personnel, locally and in other states, and handle personnel related matters
Resolve complex claim matters with adjusters, supervisors, attorneys and employers
Provide exceptional customer service and support to all internal/external stakeholders
Participate in claim file reviews with insureds, brokers and third party administrators’ claims personnel
Provide technical direction to third party administrators
Coordinate with Workers’ Compensation supervisors on plant level customer issues
Report to Ford Motor Company Program Manager on "current state of the business"
Develop and implement "Best Practices" claims handling procedures to assure that quality claims service is rendered to all locations
Approve key purchased services requisition at initial stage and work with vendor on costs
Manage strategic and operational management of all vendor relationships
Review medical, investigative and legal vendors for addition to approved panels
Ensure compliance with Ford standards and jurisdictional requirements
Support Ford Motor Company's internal controls and audit requirements
Perform other duties as required by management
12+ years experience in the field of Workers’ Compensation, both for self-insured and fully-insured clients
10+ years’ experience as a claims supervisor
Proven leadership skills and experience to direct performance management in a team to optimize bottom line results
Strong communication skills to interface internally and externally
Ability to effectively
Strong strategic management and planning skills
Expertise in the field of Michigan Workers’ Compensation law
Experience with multistate Workers’ Compensation claims and regulations

Medical Workers Compensation Adjuster Resume Examples & Samples

Under close supervision and guidance, and within narrowly defined limits and authority levels, actively manage medical only claims to ensure only medical bills appropriate to the claim are paid on a timely basis
Manage a diary and complete tasks to ensure that cases are resolved timely and at the right financial outcome
Properly set claim reserves
Direct and manage outside vendors which might include attorneys, medical personnel and investigators

Workers Compensation Claims Technician Resume Examples & Samples

Conducts investigation to secure essential facts from injured worker, employer and providers regarding workers' compensations through telephone or written reports. Verifies information from claimants, physicians, and medical providers to assess compensability and/or causal relation of medical treatment, and make evaluations for cases with typically up to twelve weeks disability and/or claim specific on-going medical management
Provides on-going medical and/or disability case management for assigned claims. Initiates calls to injured worker and medical provider if projected disability exceeds maximum triage model projection or to resolve medical treatment issues as needed. Maintains contact with injured worker, provider and employer to ensure understanding of protocols and claims processing and/or to confirm return-to-work date or medical treatment
Continually assesses claim status to determine if problem cases or those exceeding protocols should be referred to Claims Service Team and/or would benefit from, MP RN review or other medical /claims resources. Refers case to SDU/MP RN if light duty potential is identified at any point or for issues involving medical treatment or dispute involving disability or based on exception reports and defined departmental protocols. Arranges Independent Medical Exam and Peer Review as necessary
1 to 3 years of related customer service experience or applicable insurance knowledge

Workers Compensation Lead Claims Adjuster Resume Examples & Samples

Interacts extensively with various parties involved in the claim process. Will professionally represent Gallagher Bassett in client claims reviews with minimal supervisor support
Demonstrated ability to present cogent presentation of case facts, and a concise plan for closure
Independently able to comply with carrier reporting requirements; actively monitors carrier reporting thresholds and able to properly report those files reaching thresholds to the carrier
Able to recognize and independently pursue excess insurance recoveries
Demonstrates superior technical expertise through proper file documentation
7 or more years related claims experience required

Workers Compensation Claims Supervisor Resume Examples & Samples

Supervision of claims staff including staff hiring, training, coaching, counseling and evaluating performance
Conduct file reviews, audits; and monitor quality of work to ensure optimum achievement of established goals and is in accordance with client and Company guidelines
Responsible for the claim unit’s compliance to regulatory requirements
Maintains knowledge of new and existing regulations, case law and court decisions, which could affect claims handling procedures
Responsible for adequate reserves, timely settlements, and reasonable expenses within established authority level
Provide coverage in the absence of examiner staff
3+ years of Nevada workers compensation claims experience handling indemnity and catastrophic claims
Prior leadership and training experience
Intermediate proficiency with Microsoft Word (create and modify documents), Microsoft Excel (create and modify spreadsheets, ability to use pivot tables), and Microsoft Outlook (ability to use email and calendar)
Advanced knowledge of case law and state Workers Compensation laws, subrogation, reserve setting and litigation management
Ability to multi-task and understand multiple products and multiple levels of benefits within each product

Workers Compensation Claims Trainee Resume Examples & Samples

Work with a customer service associate to learn the claims assignment routine
Receive new loss reports, enter claim into claims system and assign claim to the appropriate claims representative
Follow up for any pertinent information not included on the initial loss report
File BI indexes and PILR’s when possible
Process and handle low severity losses up to authority issued at the discretion of the supervisor to include limited investigation, composing of correspondence, processing of payments and creation of diary for follow up
Review all mail received in imaging system and properly route to correct person whether it be new loss or new mail for an existing claim according to new mail procedures
File and import e-mails, letters, and other correspondence received from outside sources
Respond to agent status requests and handle routine inquiries from others including, but not limited to, claimants, insureds, and agents
Assist in typing/transcribing memos, reports, and captioned outlines for the team
Participate in relevant continuing education
A four year college degree, preferred
Insurance experience is a plus
Strong verbal and written communication skills with the ability to build strong relationships
Ability to manage multiple priorities/tasks in a timely manner
Must have strong decision making skills

Workers Compensation Resume Examples & Samples

Aggressively expand technical acumen to facilitate career advancement to high level positions within Claims upon paid
Comfort in making decisions after seeking out information
Post - secondary preferred

Workers Compensation Senior Claim Adjuster Resume Examples & Samples

Exercises proper judgment and decision making to analyze the claims exposure, to determine the proper course of action and to appropriately settle the claim
Interacts extensively with various parties involved in the claim process
Able to clearly communicate concise action plans, and present plans for moving the case to conclusion
Will demonstrate complete knowledge of the claim file process through presentation of actions and responses to client questions
Processes claims consistent with clients' and corporate policies, procedures and "best practices" and also in accordance with any statutory, regulatory and ethics requirements
Demonstrated ability to comply with carrier reporting and threshold requirements
Able to recognize and pursue excess insurance recoveries. Incumbents will have the ability to handle a full case load, with proven ability to handle cases of increased severity
High school diploma
5 or more years related claims experience required
Appropriately licensed and/or certified in all states in which claims are being handled
Extensive knowledge of accepted industry standards and practices Computer experience with related claims and business software
Bachelor's Degree

Workers Compensation Telephonic Case Manager Resume Examples & Samples

Evaluates and coordinates medical and rehabilitative services using cost containment strategies. Plans a proactive course of action to address issues presented to enhance the injured employee’s short and long-term outcomes
Assesses and identifies barriers to recovery; determines goals, objectives, and potential alternatives to care. Works as an advocate to promote the injured employee’s best interest, addressing treatment alternatives, coordination of quality, cost effective health care and rehabilitative services
Assists the injured employee by providing medical and disability education and coordinating on-site job analysis, work conditioning, functional capacities, and ergonomic evaluations
Negotiates and assists employers with the development of transitional sedentary or modified job duties based on the injured employee’s functional capacity to ensure the injured employee’s safe and timely return to work
Monitors, evaluates, and documents case management activities and outcomes including, but not limited to, case management approaches, over or under utilization, inappropriate care, effective treatment, permanent or temporary loss of function, failed or premature return to work, and non-compliance
Adheres to all appropriate privacy, security and confidentiality policies and procedures

Coordinator Workers Compensation Resume Examples & Samples

Collaborate with Business Partners to provide guidance to injured Crewmembers on how to best navigate rules, regulations and policies of the Workers Compensation process
Communicate effectively and timely to all inquiries
Interacts with various internal and external groups such as Benefits, front-line Workgroups, JCCF, Payroll and the Insurer
Interact and cultivate relationships with all external Business Partners who provide services for our injured Crewmembers
Collaborate within the department to ensure claims are processed properly and efficiently
Complete and file State forms in accordance with the State guidelines
Creative problem solver who can assist Crewmembers throughout the process while demonstrating a high level of sensitivity, empathy, and care that align with the Company’s values
Proficient in the use of systems and applications to support Workers Compensation functions (SAP, Intellirisk, MS Office Suite, GRM, Rainmaker, etc.)
Maintains documentation to ensure quality control by tracking communications with Crewmembers and Business Partners. This includes maintaining sharepoint, telephone logs, emails and file notes
Support front-line Workgroups by furnishing injury reports etc
Must maintain strict confidentiality with personal information
Assist Risk Management/Workers Compensation with training and educational resources
Supports Managers in key initiatives
Assist with the day-to-day administrative tasks to support the team
One (1) year with high volume Customer Service or related experience
Proficient with the Microsoft Office suite
Ability to work well with others and complete tasks
Ability to work in a high-pressure team environment
Ability to rapidly resolve issues and recognize when escalation is necessary
Ability to effectively interface with people on all levels
Available for occasional overnight travel (10%)
One (1) year with Workers Compensation or claims handling experience
Potential need to work flexible hours and be available to respond on short-notice
When working or traveling on JetBlue flights, and if time permits, all capable Crewmembers are asked to assist with light cleaning of the aircraft
Must be an appropriate organizational fit for the JetBlue culture, that is, exhibit the JetBlue values of Safety, Caring, Integrity, Fun and Passion
Promote JetBlue’s #1 value of Safety as a Safety Ambassador, supporting JetBlue’s Safety Management System (SMS) components, Safety Policy and behavioral standards
Equipment: Computer and other office equipment

Manager Workers Compensation Resume Examples & Samples

5 years’ experience in Workers’ Compensation Claims and Policy Management
Extensive working knowledge of the QLD and NSW Coal Mining Workers Compensation legislation
Tertiary qualifications (or working towards) in relevant discipline (eg OT, Physio, RC, OHS)
Technically competent in Workers Compensation Case Management including complex claims, disputes, Regulatory matters, common law and litigated claims
Experience in Insurance Processes and Management
Current Return to Work Coordinators certification and associated experience
Passion for safety as a way of life essential

Senior Claims Handler Workers Compensation Resume Examples & Samples

Juris Doctor and 5 or more years of experience in the Claims or Litigation area
7 or more years of claims handling experience with 2 or more years in line of business
Ability to obtain and maintain required adjuster license
Organization and time management skills
AIC
SCLA
CPCU

Workers Compensation Technical Claims Manager Resume Examples & Samples

Juris Doctor and 5 or more years of experience in the Claims area
Knowledge and skill of claims handling
Negotiation experience
Experience in workers compensation claims

Workers Compensation Analyst Resume Examples & Samples

Educate employees with work related injuries/illnesses on the benefits available under state and federal statutes
Estimate reserves required to satisfy the liability incurred as a result of a workplace injury/illness
Manage approved vendor services to maximize return on investment
Travel between Groton, CT and QP, RI workers' compensation offices as necessary
Position requires an active claim adjusting license as required to perform certain transactions on claims filed under CT or RI state jurisdiction. Candidate must have or be able to obtain claim adjusting license upon hire
Exceptional organizational, verbal and written communication skills required
Quantitative problem solving and analytical skills
Working knowledge of microsoft software (word & excel)
Strong work ethic is required to manage assigned caseload of claims along with a pleasant demeanor in dealing with injured workers, medical providers and other third parties

Claims Adjuster Workers Compensation Resume Examples & Samples

May process complex lifetime medical and/or defined period medical claims which include state and physician filings and decisions on appropriate treatments recommended by utilization review
Travels as required
Working knowledge of regulations, offsets and deductions, disability duration, medical management practices and Social Security and Medicare application procedure as applicable to line of business

Claims Representative Workers Compensation Resume Examples & Samples

Develops and manages workers compensation claims' action plans to resolution, coordinates return-to-work efforts, and approves claim payments
Approves and processes assigned claims, determines benefits due, and manages action plan pursuant to the claim or client contract
Manages subrogation of claims and negotiates settlements
May process complex lifetime medical and/or defined period medical claims which include state and physician filings and decisions on appropriate treatments recommended by utilization review
Knowledge of regulations, offsets and deductions, disability duration, medical management practices and Social Security and Medicare application procedure as applicable to line of business

Claims Examiners Workers Compensation Resume Examples & Samples

Analyzes and manages complex or technically difficult claims by investigating and gathering information to determine the exposure on the claim; manages claims through well-developed action plans to an appropriate and timely resolution
Negotiates settlement of claims within designated authority
Calculates and pays benefits due; approves and makes timely claim payments and adjustments; and settles claims within designated authority level
Manages claim recoveries, including be not limited to subrogation, Second Injury Fund excess recoveries and Social Security and Medicare offsets
In-depth knowledge of appropriate insurance principles and laws for line of business handled, recoveries offsets and deductions, claim and disability duration, cost containment principles including medical management practices and Social Security and Medicare application procedure as applicable to line of business

Workers Compensation SME Resume Examples & Samples

Provide overall client development leadership and political strategy for Conduent activities in Public Sector
Assists the LOBS in pipeline management and forecasting
Works directly with the leadership of other Conduent organizations
Responsible for community and political involvement, ensures that Conduent is viewed as a good corporate partner to the State and the local community
Work with the appropriate LOB and sales team in qualifying opportunities, establishing effective solutions and executing effective win strategies
Coordinates governmental relations activities with the Conduent Government Affairs Office and serves as primary Conduent local resource for contact with political leadership
Develops and maintains executive-level relationships
Works directly with corporate Executive Sponsor for state/region
Must have high level understanding of political, operational, sales, new and existing business activities in state/region
Subject Matter Expert with strong demonstrated experience with workers compensation systems and processes
Demonstrated experience with the applications said industry run, regulatory environment, buying patterns, funding sources, etc
Experience in Business Process Outsourcing (BPO) highly preferred. Our services focus on case management, medical bill review, etc
Bachelor’s degree

Coordinator, Workers Compensation Resume Examples & Samples

Maintain and record transactions and communications
Enter all First Aid Only Workers Comp and General Liability claims
Perform data entry into STARS for all Workers Comp claims as assigned
Sort and distribute all incoming insurance faxes by region
Assist the Workers Comp team with claims case load from beginning to end, ensuring all Workers Comp claim files are closed
Open, scan and electronically file all incoming Insurance team mail
Distribute monthly hospital list updates sent to vendors
Administer the distribution of all state required insurance postings
Create and continuously update an Excel tracking spreadsheet for state required insurance postings
Assist in the completion and distribution of all Practice Hospital OSHA logs. Other job duties as assigned
High School Diploma or GED required. Associate’s degree preferred, or the equivalent combination of education, training and experience that provides the required knowledge, skills, and abilities
Minimum one year of relevant office experience with exceptional organizational and multi-tasking skills required
Fundamental knowledge of Workers Compensation concepts preferred

Workers Compensation Claims Analyst Resume Examples & Samples

Imports inbound and exports outbound HIPPA complaint claim (837) and payment (835) files from claims adjudication system
Resolves pended or rejected electronic data interchange (EDI) claim and payment transactions
Appeals underpaid claims to payers
Maintains state WC fee schedules in the claims adjudication system
Analyzes payer payments verses applicable state WC fee schedule to determine if payment requires appeal
Obtains explanation of payments from payers that are not sent with the checks
Maintains deposit reconciliation database with current bank deposits and posted payment data
Downloads daily check images and documentation from the bank’s website
Process and reconciles payment transactions
Prepares standard and ad hoc reports from claims adjudication system utilizing database reporting tool
Delivers excellent customer service and creates effective working relationships with all internal and external customers
Good organizational skills and ability to prioritize to meet deadlines
Strong analytical skills, including troubleshooting and problem solving
Strong attention to detail and commitment to quality and process improvement
Excellent telephone, computer and technological skills
Excellent written and oral communication skills at multiple levels, including presentation skills
Strong motivational and facilitative skills
Knowledge of Windows based office technologies (i.e. Word, Excel, Access, Outlook, etc.)
Position requires a minimum of 2 years’ experience in a healthcare environment
Comprehensive understanding of the healthcare insurance administration claims process
Knowledge of health care standards and medical reimbursement policies, procedures and standards

Manager, Workers Compensation Resume Examples & Samples

Administers the workers' compensation insurance program for THP
Assists the VP HR and VP of Finance with the preparation of the workers' compensation program budget
Communicates claims cost and reserve information to financial auditors as necessary
Advises departments and leadership about the status of claims, loss experience trends and program costs
Provides claims data for the employee injury and incident loss runs and maintains required injury and illness records
Directs and monitors the activities and performance of the workers' compensation third party claims adjusting administrator to ensure compliance with applicable regulations
Develops and manages the Return to Work/Transitional Duty programs
Develops and provides or arranges for training programs relating to workers' compensation laws, benefits, policies and loss control
Consults with our third-party claim adjusting administrator(s) and the appropriate outside providers to select legal counsel for litigated workers' compensation cases and evaluates legal counsel performance, utilization and effectiveness
Conducts workers' compensation claims investigations and directs third party claims adjusting administrator workers' compensation claims investigation activities
Determines actual time missed from work due to work related injuries and illnesses and provides accurate information to meet OSHA record-keeping requirements
Develops and maintains close communication with medical providers providing services for injured employees and serves as the liaison between medical providers, injured employees and department supervisors
Communicates benefits and program goals with department managers and injured workers for loss control
Reviews and approves all claim settlements proposed by the third-party claims adjusting administrator
Develops, implements and monitors workers' compensation claims reporting forms, procedures and activities
Works with leadership to select and contract for third-party claims adjusting administration and other workers' compensation program related services and products
Evaluates accident reports, ensuring the timely processing of medical bills and temporary total disability benefits; reviews medical reports, witness statements, department investigation results, and other documentation
Maintains subrogation records and files for those incidents involving third parties. Sends subrogation letters to third parties to obtain reimbursement of monies spent for medical treatment, time loss, and awards and settlements paid; submits amounts paid for medical treatment and/or temporary total disability benefits to seek reimbursement
Reviews documentation to determine whether medical bills and temporary total disability benefits should be continued; authorizes payment of medical bills and temporary total disability benefits upon receipt of proper documentation
Advises and/or assists departments in conducting investigation of accident reports, including interviewing of witnesses and procurement of relevant documentation
Reviews accident reports to identify patterns of injury and to determine whether unsafe conditions contributed to the accident; advises departments of trends in injuries and proper safety procedures that may result in reduction of injuries; provides department with information that will aid in reducing accidents and improve safety
Trains THP claims coordinators in the proper procedures and forms to be utilized in workers' compensation matters and the preparation of accident reports, notices of absence, and notices of return to work in accordance with company regulations and the Workers' Compensation Act
Documents telephone conversations, witness statements, medical reports, accident investigation results, and payment of medical bills; prepares summaries of medical reports; ensures that state Industrial Commission forms are properly prepared and filed
Attends seminars, conducts research, and maintains liaison with individuals in the medical community and health care fields to keep abreast of current medical procedures and medications as it relates to Workers’ Compensation
All other related duties as assigned
Five plus years’ experience in the management of Workers' Compensation claims and claims administration
Any combination of training and experience equivalent to completion of a Baccalaureate Degree from an accredited college or university in business administration, insurance or a related field
Experience with multi-state Workers' Compensation claims administration and regulations a plus
Excellent understanding of the organizations goals and objectives
Ability to communicate effectively with all levels of staff
Highly self-motivated and directed, with keen attention to detail
Proven analytical and creative problem-solving abilities
Ability to work in a team-oriented, collaborative environment
Ability to foster effective relationships and build consensus through the all levels of leadership in the organization
Knowledge and ability to work on large-scale complex projects that include multiple strategic goals and multiple tactical tasks
Knowledge and ability of needs, goals, deliverables and interdependencies of other functional departments
Highly resourceful team-player, with the ability to be extremely effective independently

Claims Team Lead Workers Compensation Resume Examples & Samples

Supervises multiple teams of examiners, multiple product line examiners and/or several (minimum seven) technical operations colleagues for a wide span of control; may delegate some duties to others within the unit
Performs quality review on claims in compliance with audit requirements, service contract requirements, and quality standards
Thorough knowledge of claims management processes and procedures for multiple product lines

Workers Compensation Claims Representative Resume Examples & Samples

Bachelor’s degree preferred or 3 years of work experience
Ability to maintain highly confidential information
Ability to review and interpret complex and detailed documents such as contracts, medical reports and insurance regulations
Ability to multi-task, prioritize, and remain organized

Workers Compensation Claims Supervisor Resume Examples & Samples

5+ years’ experience in workers compensation insurance industry
Basic understanding of laws, principles of coverage, liability, and insurance industry in general, with specific emphasis on workers compensation
Ability to manage personnel administration including employee evaluations and salary administration

Assistant Workers Compensation Claims Manager Resume Examples & Samples

Together with the Claim Manager develops short-range area plans and budget designed to achieve company goals and objectives
Secures, evaluates and develops staff and develops an organization structure which will ensure the level of performance necessary to achieve departmental and company objectives. Ensures that staff works effectively as a team
Keeps the Claim Manager informed of current case status through regular communications and by issuing periodic reports
Ensures that all AmTrust policies, procedures and controls are followed, and that reports are completed accurately and submitted on time. Ensures that staff is informed of these procedures. And consults with the Claim Manager on claim areas needing improvement
Works with the staff to ensure that that approved vendors are being used. Monitor our attorney vendor panel; meet with the firms to discuss action plans on the mitigation of our claims to ensure cost-effective and efficient results
Work with the Manager on monitoring claims, ensuring pro-active cost-effective and creative cost management. Addressing areas needing improvement to obtain optimal results
Work with Manager and Supervisors to manage the negotiation and negotiates claims settlements, participates and testifies before hearings, trials and depositions ensuring timely and cost-effective resolution
Supports AmTrust sales and marketing goals by participating with underwriting in sales activities including new business development
Work with the management team to evaluates the performance of the claims staff at regular intervals to ensure the consistent implementation of company standards and internal quality control, by conducting audits
Maintains current knowledge of related laws and regulations and communicates to staff , Manager and company President
Performs other projects as assigned

Workers Compensation Claims Assistant Resume Examples & Samples

This position supports Workers' Comp Examiners
Assist examiners in contacting insureds or other involved persons to obtain missing or incomplete information
Provide customer service, such as giving limited instructions on how to proceed with claims, completing timely and accurate responses to customer inquiries and resolving minor complaints which arise during the claims handling process
Performs data entry functions (claim checks, claim file updates, forms, form letters, electronic interfaces, etc.) as directed by claims examiner or supervisor
Receives and/or returns telephone calls as directed by claims examiner
Performs general maintenance of claims documents in the claim files
Other tasks as assigned by examiners or supervisor
Self- organized and detail oriented
Professional telephone demeanor and good oral communication skills
Basic understanding of business technology
Two to four years of experience in an insurance claims department or related experience
Workers' Comp support experience a plus

Workers Compensation Resume Examples & Samples

Assist adjusters in contacting insureds or other involved persons to obtain missing or incomplete information
Provide customer service, such as giving limited instructions on how to proceed with claims, completing timely and accurate responses to customer inquiries and resolving minor complaints which arise during the claims handling process
Performs data entry functions (claim checks, claim file updates, forms, form letters, electronic interfaces, etc.) as directed by claims adjuster or supervisor
Performs general maintenance of claims documents in the claim files
Handles, manages and maintains a case load of assigned claims on an individual basis
Approves medical treatment on their designated claims within a timely manner
Helps communicate between the claimant, employer & doctors offices where needed
Responsible for handling daily duties that are required by the department
Performs monthly reviews required for file closures
2 to 4 years of experience in an insurance claims department, or related experience specifically in medical claims
Basic knowledge of medical claims procedures and policies
Proven organization and detail-orientation skills
Ability to learn new procedures quickly and adapt to a changing environment
Ability to work well under pressure and multi-task in a fast-paced environment
Basic understanding of business technology

Workers Compensation Claims Consultant Resume Examples & Samples

Advanced knowledge of Workers Compensation, General Liability, Automobile, Property and coverage, claims, and state laws governing claims handling
Extensive insurance industry knowledge through experience and/or course work
Firm understanding of Workers Compensation, General Liability, Automobile and Property TPA claims handling
Demonstrated ability to instill confidence and comfort in external clients so that clients look to Lockton not just as an insurance broker, but as a business partner
Working knowledge of Microsoft products (Word, Excel, Outlook) or similar software applications
Ability to compile, analyze, present and interpret loss runs and statistical information
Ability to utilize carrier's and TPA's on-line systems to retrieve and deliver reports and claims documentation
Organizational and time-management skills to prioritize heavy workload to meet time-sensitive deadlines (most requiring immediate response to client)
Demonstrated ability to understand and execute oral and written instruction
Ability to make decisions in compliance with established Lockton standards of quality performance and service
Demonstrated professional and tactful negotiation and persuasion skills
Ability to organize claims and loss data
Demonstrated interpersonal communication skills and ability to interact with associates at all levels of responsibility
Ability to communicate professionally with internal and external clients and develop strong client relationships
Exemplary presentation skills, including presentation and execution
Demonstrated analytical and problem-solving skills, including research and investigation
Ability to effectively delegate tasks as appropriate
Demonstrated understanding of when to proceed alone and when to involve Claims Manager, Supervisor or other CID associates
Proven leadership and problem-solving skills, including resolving unusual and complex issues
Ability to coach and mentor other Lockton associates
Willingness and ability to expand knowledge and effectiveness in the commercial, workers compensation insurance industry by successful completion of extended classes and workshops related to insurance
Bachelor of Arts or Sciences degree in business field, related field, or equivalent practical insurance claim management experience
Proficiency in the evaluation, interpretation and communication to the client of Workers Compensation, General Liability, Automobile, and Property coverage and claims
Ability to professionally interact with businesspersons of all levels and succinctly communicate information and strategies
Substantial knowledge of the practices and procedures of Third Party Administrators, and the skill to effectively develop long term partnerships that meet client expectations and needs
Proven experience in the evaluation of the accuracy of Workers Compensation, General Liability, Automobile, and Property claim reserving practices
Proven leadership and critical thinking skills, and the ability to resolve unusual and complex issues
A keen ability to negotiate with all parties involved in the claim management process, and effectively influence positive outcomes
Compliance with established Lockton ethical business standards
Fluency in the English language, including the ability to express and hear appropriate business communications by phone or teleconference, in writing and in person

Workers Compensation Medical Claims Adjuster Resume Examples & Samples

Review, process and conclude moderate severity claims that may be limited in exposure but occasionally complex in nature
Verifies coverage and policy conditions
Completes quality investigation by gathering all pertinent information (recorded statements, review of police and medical reports, photographs and appraisals/estimates of damages, etc.)
Determines if subrogation exists and takes steps necessary to initiate recovery efforts
Documents all correspondence, reports, discussions and decisions
Fulfill state licensing agreements/requirements (if applicable) and apply knowledge of state laws and re Ability to manage relationships in a fast paced environment, while demonstrating persistence along with problem solving and decision making skills to work with customers through a variety of challenging situations
Good analytical abilities to review, exercise judgment and evaluate claims in order to make sound decisions
Knowledge of claim procedures, policies, technology, state and federal laws and insurance regulations
Experience with Workers Compensation Claims – lost time claims required
Ability to multi-task and handle large volumes of work in a short period of time
Ability to carry out detailed written or verbal instructions, ability to respond to requests effectively and efficiently and exhibit good common sense
Time management skills, organizational skills and ability to prioritize issues and tasks
Bachelor's degree preferred; however employee should possess such skills and knowledge as are normally gained in the successful completion of a four-year college program
Minimum of five years' experience handling workers compensation claims
Insurance coursework (e.g. IIA, CPCU, SCLA and AEI) is beneficial
Good knowledge of insurance theory and practices; insurance contracts and their application
Knowledge of Microsoft Office Applications and ability to learn new software programs

EH RN Workers Compensation Snmh Resume Examples & Samples

Minimum of 5 years experience required in similar position or related field
At least 3 years direct experience in risk management, workers compensation claims management
Must possess excellent interpersonal skills and be able to handle conflict in an assertive and

Workers Compensation Claims Assistant Temporary Resume Examples & Samples

Assists adjusters in contacting insureds or other involved persons to obtain missing or incomplete information
Receives and/or returns telephone calls as directed by claims adjuster
Thorough knowledge of workers' compensation claims procedures and policies

Non Subscription Adjuster Workers Compensation Resume Examples & Samples

Proficient computer skills to navigate our digital claim file systems
Excellent verbal and written communication skills
Technical skills to manage medical and legal aspects of claim handling
Ability to professionally interact at a high level with internal and external customers
Ability to effectively influence others without damaging relationships
Ability to quickly adapt to changing priorities and work practices
Excellent time management, judgment, and decision-making skills
Additional Preferred Qualifications
1 year experience in any legal-related field
1 year experience in any medical-related field
1 year experience working in a Walmart store
1 year general customer service experience
1 year insurance industry or claims experience
Insurance Adjuster License
Employment Type:Full Time

Manager Workers Compensation Resume Examples & Samples

Determines whether a claim is work-related and if a claim should be investigated
Monitors and manages the performances of the third party administrator (TPA), WC actuaries, consultants, outside WC attorneys and subcontractors, such as IME providers, networks, surveillance, and nurse case managers. Identifies and makes recommendations to resolve problems/areas of concern
Prepares utilization reports; performs trend analyses and estimates future costs. Identifies areas of concern/opportunity and makes recommendations for improvement. Implements changes, as appropriate
Develops and delivers training/support to managers regarding incident and injury reporting. . Works with loss prevention staff to develop and implement Workers’ Compensation (WC) policies and initiatives designed to reduce claim frequency and severity
Recommends setting of reserves and claim settlements. Works with WC attorneys on identifying and settling claims eligible for subrogation
Monitors reinsurance reimbursements, OSHA and other statutory reporting. Prepares and validates WC claim data submitted to actuaries
Communicates with employees, worksite liaisons/supervisors, and/or external third parties (e.g. attorneys, physicians) regarding information needed to process and adjudicate claims; e.g., medical documentation, filing status and exemption form, election to use accrued leave, return to work plans, etc. Responds to employee concerns, such as completion of paperwork, claim status, payment of medical bills, sending forms to the TPA, etc
Minimum of five years’ experience in Workers’ Compensation claim management and compliance required
Demonstrated experience interpreting, applying and explaining federal, state and local laws, codes, regulations and proceedings, and ensuring compliance required
Knowledge of NYS workers compensation laws and federal employment and safety regulations (e.g. OSHA) required
Experience with NY jurisdictions, functions and procedures of the Workers’ Compensation Appeals Board required
Experience reviewing and approving WC claims and negotiating settlements required
Healthcare industry background preferred
Proficient with MS Office and familiarity with risk management tools preferred

Workers Compensation Claims Unit Manager Resume Examples & Samples

Oversight of Claims Handling Requirements
Excellent time and organizational management skills
Minimum 5 years Workers’ Compensation and/or relevant and minimum 3 years of supervisory experience

Unit Manager, Workers Compensation Claims Resume Examples & Samples

Ensuring their Examiners are handling all aspects of the claims handling process in a timely manner which meets both York and client best practices
Conducts regular file reviews as required by York and Client Instruction/Best Practices; ensuring compliance with issuing and approving CMR’s as well as reviewing and approving all denials and reserves
Excess Reporting Compliance: files are reported on a timely basis to the excess carrier (if applicable) as well as reporting on any required forms with all supporting documentation required
Closing Ratio/Inventory Reduction: Ensuring that their team achieves a closing ratio as required by York Best Practices and/or Client Service Instructions in order to maintain or reduce file inventory
Penalties and E&O’s: Ensuring that the Examiners incur no penalties or Errors & Omissions (E&O) on the files that they handle. This should be accomplished by handling all significant claims activities in a timely manner and issuing all benefits due in a timely manner
Significant Claims Activities are properly managed from inception to resolution. These claims include but are not limited to high dollar and complex claims. This process will also include delivering exceptional customer service to our clients in partnership with our client services team
Employee Recognition: The UM will be responsible for recognizing employees for exceeding specific performance goals, receiving positive client feedback, or achieving educational goals
Training Clients: The UM will be responsible for assisting in training clients within their area of expertise and as requested by the clients
In-depth knowledge of the California Labor Code, practices & procedures and current case law (where applicable)
Strong knowledge of York’s Best Practices and client Account Instructions
Advanced working knowledge of York’s claim system and internal workflows & procedures
Minimum 3 years Workers’ Compensation and/or relevant supervisory experience
Public entity and safety officer experience is preferred

Workers Compensation Claims Unit Manager Resume Examples & Samples

Benefit Delivery is in a timely manner according to statutory requirements
Diary Compliance: Examiners are complying with York Best Practices and/or Client Service requirements for diary completion
Statutory Requirements: The Examiner will be responsible for complying with all State Statutory Requirements and maintaining all State educational requirements
External Audits Preparation & Response: The UM will be responsible for preparing for and responding to external audits in coordination with our client services team. This would include implementing changes to improve performance if necessary
Human Resources: The UM will be responsible for working closely with the Human Resource department on any performance issues, recruitment, and performance reviews
Client Relations: The UM will work with the Client Relations team on customer service issues, attend client meetings & support staff when dealing with clients
Prefer 5 years Claims Examiner experience; WCCA/WCCP may substitute for 2 years’ experience

Seeking All Levels of Workers Compensation Claims Professionals Resume Examples & Samples

Payment of all indemnity payments and responsibility for ongoing payment as needed, along with creating required DWC notices
Completing all clerical tasks assigned, such as file and serve documents to attorneys, doctors, employees and employers, bill objection letters, litigation referrals, scheduling doctor appointments, requesting records, etc
Prior workers compensation experience/knowledge strongly preferred Investigates claims to determine an injured worker’s entitlement to Workers’ Compensation benefits; Administers indemnity and medical benefits for valid Workers’ Compensation claims; Manages a caseload of claims from inception to closing or settlement
Establishes appropriate reserve levels based on financial exposure and updates reserves upon receipt of new information
Directs assistant to properly pay indemnity benefits and Awards. Issue state-mandated benefit notices within the required timeframes
Responding to questions and requests from the client
Minimum 3 years Workers' Compensation Experience

Workers Compensation Claims Assistant Resume Examples & Samples

Assist adjusters in contacting insureds or other involved persons to obtain missing or incomplete information
Other tasks as assigned by adjusters or supervisor
Self-organized and detail oriented
Two to four years’ experience in an insurance claims department or related experience

Workers Compensation Claims Intern Resume Examples & Samples

The claims administration model of AmTrust North America
The operations model
The sales model
We are looking to provide a glimpse into the insurance industry for the right candidate with the possibility for future opportunities within the claims business unit
Ideal candidate will be a college junior working towards a bachelor’s degree in Business, Communications, Criminal Justice, Philosophy, Physiology or a general Liberal Arts degree
Good analytical abilities to review, exercise judgment and evaluate information in order to make sound decisions
Ability to work independently with self-initiative and limited direction
Excellent communication skills; ability to obtain information from others and deliver information to others orally or in written form
Excellent computer skills are needed due to multiple claim systems
Sound command of the English language – its grammar, syntax and style, including an understanding of the conventions of punctuation and capitalization
Organization skills; Business math Skills; Business telephone skills
Ability to perform 80 percent sedentary work, exerting up to 10 pounds of force occasionally and negligible force frequently or constantly to move objects, including the human body. May be asked to exert up to 20 pounds of force periodically as needs arise
Able to work in Concord, CA
No specific experience is required but exposure to any insurance or finance related jobs in the past could be beneficial

Temporary Workers Compensation Claims Unit Manager Resume Examples & Samples

Ensures the following claims activities are completed by their examiners in a timely manner which meets both York and client best practices
Strong leadership skills; experienced with training and mentoring staff
Must have excellent verbal, written and interpersonal communication skills
Strong analytical, reasoning and organizational skills are essential
Medical and legal terminology and integration with Medicare
In-depth knowledge of the California Labor Code, practices & procedures and current case law

Workers Compensation Claims Bill Reviewer Resume Examples & Samples

1+ years worker's compensation bill review experience
2+ years data entry experience
2+ years customer service experience
1+ years familiarity with ICD 9 / CPT codes

Workers Compensation Claims Clerk Resume Examples & Samples

Open, sort, scan and complete initial indexing information on incoming mail
Self organized and detail oriented
Basic understanding of business technology

Analyst, SOX, Workers Compensation Resume Examples & Samples

Direct all aspects of highly complex projects with product line variables: define project scope, prepare cross functional project work plan, allocate resources, identify major milestones
Function as the project lead for cross-functional teams and ensure successful and timely execution of Worker’s Compensation audit requests
Monitor and report deliverables, status and quality
Maintain gap analysis and critical issue logs; work with business owners to facilitate alignment and resolution
Partner with Accounting, Internal Audit and third-party consultants
Develop process documentation, work instructions and other supporting documentation
Test internal controls for deficiencies and recommend remediation efforts
Provide audit deliverables to external audit
Facilitate trainings to internal colleagues for communicating audit compliant best practices
Evaluate current processes and recommend improvements where necessary
Maintain up-to-date understanding of SOX regulations
Function as a point of contact for field and internal colleagues to answer SOX/Audit questions pertaining to Worker’s Compensation
Perform data reconciliations related to worker’s compensation claims, payroll reports, actuarial triangle reports, client bill rates and TriNet’s general ledger accounts
Attend meetings, as necessary, as department point of contact - provide input and follow up on action items
Other projects and responsibilities may be added at the manager’s discretion
Must be detail oriented, highly organized and have experience facilitating project team meetings
Ability to prioritize and balance multiple priorities and projects
General knowledge of Microsoft based applications and databases such as PeopleSoft, MS Office, Excel, etc
Ability to create and comprehend reports, spreadsheets and presentations
Ability to maintain effectiveness and professionalism when experiencing change in work tasks and/or the work environment
Ability to work in a fast-paced, team environment and under deadline pressure
Strong critical thinking, problem solving, collaboration, teamwork, interpersonal and listening skills
Thorough understanding of SOX regulations to ensure compliance
Ability to communicate with colleagues and clients at all levels of the organization

Assistant Claims Team Lead-workers Compensation Resume Examples & Samples

Manages the litigation process; ensures timely and cost effective claims resolution
Manages claim recoveries, including but not limited to subrogation, Second Injury Fund excess recoveries and Social Security and Medicare offsets
Gathers important compliance/claims processing information to be presented at team meetings
Assists in interviews of adjusters, clerical staff and provides feedback to hiring manager

Senior Claims Rep-workers Compensation Resume Examples & Samples

Understand the supplemental insurance marketplace
Communicate well with Business owners and C-Level Executives
Have a great work ethic and work well independently with little supervision
Be financially motivated to build a successful career with our company
Provide superior customer service before and after a sale

Claims Rep-workers Compensation Resume Examples & Samples

Manage, control and negotiate timely and equitable claim payments and settlements in accordance with jurisdictional and fair claims practices requirements and company policy and procedures
Service the claim needs of our customers, including insureds, claimants, brokers etc. in accordance with company policy and procedures
Bachelor's degree (B. A.) preferred; 2+ years related WC claims experience Completion of insurance and/or claims courses preferred (IAA, AEI, CPCU). KY license required

Workers Compensation & LOA Programs Manager Resume Examples & Samples

Perform management duties for the department including, but not limited to supervising workers’ compensation claims administration and leave of absence programs, ensuring compliance with administration best practices
Assist employees by providing leadership of the leave of absence and worker’s compensation programs covering claims procedures, modified duties and Frontier Airlines’ return to work policy
Administer, audit and provide interpretation of state/federal laws, Company leave of absence and disability policies to include Family and Medical Leave Act, ADA, USERRA and Worker’s Compensation regulations
Oversee the modified duty program including organizing modified work and time recaps while on workers compensation to include providing coaching/counseling
Consult with and advises employees regarding their injury, appointments and loss time from work
Process, develop and administer systems to track manage records for employees on leave of absence and modified duty
Research and gather information necessary to prepare monthly frequency and severity of injury report
Communicate with health care professionals regarding employee injuries and work restrictions
Initiate investigations of suspected fraudulent injury claims
Manage service provider relationships and contracts for existing and future policies
Identify and set-up clinics for purposes of injury/worker’s compensation cases in new work locations
Coordinate unemployment claim management to include claim validity evaluation, claim appeal decisions, preparing documentation and witnesses for unemployment hearings, as well as, participate in hearings when needed
Design and prepare weekly OSHA report provided to Safety Department
Assist in the development of new programs, policies, procedures
Compose variety of correspondence to management, employees, and health care providers
Bachelor’s degree or a combination of education and equivalent industry related experience
At least 4 years comprehensive workers’ compensation administration experience
Prior supervisory or management experience in leave of absence and worker’s compensation field required
License or certification in Workers’ Compensation must be maintained
Airline background a plus
Union experience preferred Knowledge, Skills and Abilities
Demonstrates technical orientation in the field of leave of absence and workers compensation
General knowledge of the Workers’ Compensation regulations
Proficient at Microsoft Office products including Word, Excel and general computer usage
Knowledge of and ability to use disability management database system
Ability to counsel and coach employees and provide corrective feedback
Must work in a team environment, maintain good working relationships with internal customers, outside agencies and general public

Excess Workers Compensation Claim Consultant Resume Examples & Samples

Manages all types of investigative activity or litigation on major claims, including the posting of appropriate reserves in a timely manner. Coordinates discovery and litigation strategy with staff counsel or panel attorneys
Negotiates highly complex settlement packages, and authorizes payment within scope of authority, settling claims in most cost effective manner and ensuring timely issuance of disbursements
Coordinates third party recovery with subrogation/salvage unit
Works with attorneys, account representatives, agents, doctors and insureds regarding the handling and/or disposition of highly complex claims
Ability to deal with ambiguous situations and issues
Creativity in resolving unique and challenging business problems
Ability to manage and prioritize multiple projects
Typically a minimum eight years claims experience
Must have a minimum of eight years of handling primary workers compensation claims

Workers Compensation Resume Examples & Samples

Minimum of 5 years experience required in similar position or related field
At least 3 years direct experience in risk management, workers compensation claims management
Must possess excellent interpersonal skills and be able to handle conflict in an assertive and

Claims Assistant Workers Compensation Resume Examples & Samples

High school diploma or GED and a minimum of 1 year transferrable work experience within an office environment
Ability to pass any required licensing exams within three attempts
Excellent written, verbal and mathematic skills
Working knowledge of current PC software such as Word and Excel. Familiar with medical terminology
Licensed for all states in which claims are being handled
One year relevant Worker’s Compensation experience

SIU Case Manager Workers Compensation Resume Examples & Samples

Maintains thorough, accurate and timely case records by following established Best Practices for file documentation
Makes recommendations for claim resolution by presenting findings and proposing solutions of limited scope
May participate in building and enhancing organizational capabilities by developing and participating in the delivery of fraud awareness or regulatory compliance training
Develops knowledge and expertise related to insurance fraud by learning about related law, regulations, trends, and emerging issues and participating in insurance fraud or related professional associations
Strong interpersonal, oral, and written communication skills
Developing ability to exercise good judgment and make sound business
Developing problem solving skills
Ability to travel occasionally (less than 5%)
Up to two (2) years of experience conducting investigations or handling insurance claims preferred

SIU Senior Case Manager Workers Compensation Resume Examples & Samples

Conducts detailed analysis and completes thorough and timely investigations of suspected claim and/or provider fraud by following Best Practice Guidelines and collaborating with insureds, claimants, witnesses and experts
Develops and executes investigation strategy in collaboration with claim professionals, counsel, experts, insureds, and other stakeholders
Generally manages investigation activities independently, but requires guidance with unfamiliar or unusual issues; and coordinates/ oversees vendor service partner activities in the field
Maintains detailed, accurate and timely case records by following established Best Practices for file documentation and by creating comprehensive reports of investigative findings, and conclusions
Makes recommendations for claim and/or provider resolution by presenting findings and proposing solutions of moderate scope
Participates in process and outcome improvements by analyzing, summarizing, and reporting on key metrics, identifying opportunities and participating in the design and implementation of process or procedural improvements
Participates in building and enhancing organizational capabilities by developing and participating in the delivery of fraud awareness or regulatory compliance training and mentoring lower level SIU staff
Contributes to knowledge sharing with outside agencies by presenting cases of suspected claim fraud and/or testifying on behalf of the company in civil or criminal matters
Continuously develops knowledge and expertise related to insurance fraud by keeping current on related law, regulations, trends, and emerging issues and participating in insurance fraud or related professional associations
Solid knowledge of property and casualty claim handling practices
Strong technical knowledge of practices and techniques related to investigations and fact finding. For roles focused in an area of specialty (medical provider investigations), strong technical knowledge of respective specialty practices is required
Strong interpersonal, oral, and written communication skills; ability to clearly communicate complex issues
Ability to work independently, exercise good judgment, and make sound business decisions
Strong ability to analyze complex, ambiguous matters and develop effective solutions
Proficiency with Microsoft Office applications and similar business software, and understanding of relational databases information querying techniques
Ability to adapt to change and value diverse opinions and ideas
Developing ability to implement change
Ability to travel occasionally (less than 10%)
Bachelors degree or equivalent professional experience
Minimum of three to five years of experience conducting investigations in the area of a) insurance fraud, b) law enforcement, c) civil or criminal litigation, or d) similar field
Professional certification or designation related to fraud investigations strongly preferred (e.g., CFE, CIFI, FCLS, FCLA, or similar)

Workers Compensation Claims & Risk Analyst Resume Examples & Samples

Workers Compensation Claims Management
Receive copies of all First Reports of Injury and review to
Identify any "red flags" regarding the injury and the employee
Identify loss trends and ergonomic issues to address with ESH
On appropriate cases, such as questionable "red flagged" cases, lost time cases, etc
Contact the claimant's manager to determine if any performance, attendance, or other issues exist
Determine if it is appropriate to notice insurance carriers. When warranted, TPA places primary carriers on notice and Unisys places excess carriers on notice. Notice would be needed if claim meets certain criteria such as head/brain injury, amputations, etc
Review all new liability claims and report to TPA with handling instructions
Secure any contracts or other internal documents pertinent to the claim.Search Jobs US

Workers Compensation Case Manager Resume Examples & Samples

Bachelor’s Degree in Nursing, or, Nursing diploma from a State approved program, or, Associate’s degree
License and current registration to practice as a registered professional nurse in New York State
3+ years’ clinical worker’s compensation or case management experience
Excellent oral communication and organizational skills
Proficient with personal computers, including word processing, spreadsheet/chart/graph preparation
URAC-recognized certification in case management (CCM, CDMS, CRC, CRRN, or COHN)
Knowledge of state workers’ compensation law and practices
Experience in rehabilitation services industry, vocational/ occupational/ industrial nursing

Claims Adjuster Workers Compensation Resume Examples & Samples

Processes low level workers compensation claims determining compensability and benefits due on long term indemnity claims, monitors reserve accuracy, and files necessary documentation with state agency
Develops and coordinates low level workers compensation claims' action plans to resolution, return-to-work efforts, and approves claim payments
Approves and processes assigned claims, determines benefits due, and administers action plan pursuant to the claim or client contract
May process low-level lifetime medical and/or defined period medical claims which include state and physician filings and decisions on appropriate treatments recommended by utilization review
Developing knowledge of regulations, offsets and deductions, disability duration, medical management practices and Social Security and Medicare application procedure as applicable to line of business

Workers Compensation Administrator Resume Examples & Samples

Knowledge of workers’ compensation claims management
Knowledge of Tennessee and Mississippi workers’ compensation statutes, case law and regulations
Ability to do presentations before groups of people
Ability to maintain positive working relationships with co-workers and other department or business partners
Ability to set priorities, coordinate multiple tasks and organize tasks
Ability to read and comprehend complex written material such as legal documents and medical summaries
Skill in negotiating and persuading individuals including Associates, Leaders and claims management partners
Ability to work without close supervision and to exercise independent professional judgment
Proficiency with MS office including Excel and PowerPoint
Responsible for the day-to-day coordination of the MLH workers’ compensation program in partnership with the third party administrator
Analyzes and prepares reports for purposes of identifying trends, measuring progress and determining effectiveness of the program
Provides support in administration of the workers’ compensation program
Assists in the administration of the Leave of Absence and disability claims process while ensuring the best possible Associate experience

100

Senior Claims Analyst, Workers Compensation Resume Examples & Samples

Help achieve equitable, cost efficient case resolution by optimizing company resources for most favorable outcomes, timely resolution of cases, and appropriate use of medical and investigation resources
Supervise, develop, assist and participate in the evaluation of Work Comp Claims Analysts
Work closely with external partners including TPA, medical providers, outside counsel, investigative agencies, and nurse case managers while coordinating with Charter stakeholders as part of the claims management process to ensure the proper processes are followed
Secure information and evidence from the operating business units regarding workers’ compensation claims
Participate in claim audits of Third Party Administrators
Coordinate and participate in claim reviews for all operating business units
Pursue appropriate educational opportunities to maintain professional competence and certification requirements
Assist in special projects as directed by the Risk Management team
Travel as needed, although expected to be minimal

101

Workers Compensation Assistant Medical Director Resume Examples & Samples

Providing medical expertise to MDO staff regarding authorizing of licensed providers; granting licenses to medical bureaus, medical centers, and laboratories
Assisting in the development of educational programs and trainings for WCB staff and external stakeholders on relevant topics including Medical Treatment and Impairment Guidelines, medical-legal issues, general medical conditions and other related topics
Providing medical expertise to the Chair and the Executive Staff, including Members of the Board as requested
Investigating complaints and incidents related to provider medical issues as assigned by Medical Director
Providing medical expertise and guidance to assist staff with difficult investigations, and directly investigating the more complex cases
Preparing clear and concise reports regarding findings and recommendations and discuss with the Medical Director to jointly develop a plan of action to address the recommendations

102

Claims Adjuster Workers Compensation WA Resume Examples & Samples

Manages workers compensation claims determining compensability and benefits due on long term indemnity claims, monitors reserve accuracy, and files necessary documentation with state agency
Develops and manages workers compensation claims' action plans to resolution, coordinates return-to-work efforts, and approves claim payments
Approves and processes assigned claims, determines benefits due, and manages action plan pursuant to the claim or client contract
Ensures claim files are properly documented and claims coding is correct

103

Workers Compensation Analyst Resume Examples & Samples

Monitors and administers claims
Reports on generation and benchmarking TPA adjuster performance
Maintains databases and develops metrics
Identifies trends for communications with management based on claims by type, cause, frequency and severity
Knowledge and ability to use Risk Management Information Systems (RMIS)
Knowledge of Workers’ Compensation law, rules and regulations
Ability to communicate clearly and convey information in an organized, credible and concise fashion
Capable of performing duties in both an independent and team setting. Demonstrates high commitment to group goals and regularly acts to promote positive and productive working climate

104

Claims Representative Workers Compensation AZ Resume Examples & Samples

Ensures claim files are properly documented and claims coding is correct
Maintains professional client relationships
Travels as required

105

Workers Compensation Claims Program Manager Resume Examples & Samples

Managing the Claims Process: Through the Unit Managers, and in coordination with other departments, the Manager, Workers Compensation Claims will be responsible for planning, directing and maintaining the department’s claims process from the inception of a claim to its resolution and closure. This process will also include delivering exceptional customer service to our clients in partnership with our client services team
Oversight of the Department: Job duties will include the process of reviewing and evaluating the performance of the assigned department, including: training, quality assurance, customer service, innovation, staffing and recruiting
Staffing and Recruitment: In coordination with the Unit Managers, the Manager, Workers Compensation Claims is responsible for the staffing and recruitment of the claims staff for their assigned department
Strong Management Skills
Technical and logical claims process knowledge and application
Strong Organizational Skills
Effective and accurate verbal communication and written skills
Ability to multi-task projects
TECHNICAL/PROFESSIONAL KNOWLEDGE AND SKILLS: Keep up with current developments and trends in the insurance industry. Display a strong work ethic demonstrated in attendance, punctuality, maturity and dedication. Maintain a positive attitude
ADAPTABILITY: Maintain effectiveness when experiencing major changes in work tasks or the work environment. Adjust effectively to work within new structures, processes, requirements or cultures. Able to change priorities to meet multiple deadlines while being responsive to customer needs
COLLABORATION: Cooperate with others. Establish and maintain good working relationships
COMMUNICATION: Clearly convey information and ideas through a variety of media to individuals or groups in a manner that engages the audience and helps them understand and retain the message
CONTRIBUTING TO TEAM SUCCESS: Actively participate as a leader of the team to move toward the completion of goals
CUSTOMER FOCUS: Make internal and external customers, and their needs, a primary focus of one’s actions. Develop and sustain a productive department
INITIATING ACTION: Take prompt action to accomplish objectives. Take action to achieve goals beyond what is required. Anticipate consequences of decisions and actions. Communicate recommendations to take preventative steps and initiate further action
MANAGING WORKFLOW: Manage time and resources to ensure that work is completed efficiently. This includes delegation of work to the team and management of that process until completion and resolution of the task
QUALITY ASSURANCE: Accomplish tasks by considering all areas involved, no matter how small. Show concern for all aspects of the job. Accurately check processes and assignments, meet demanding deadlines, learn quickly and exhibit organization in work habits
FLEXIBILITY: Maintain stable performance under pressure or opposition, such as, time demands or job ambiguity. Handle daily job responsibilities in a way that is acceptable to others and to the organization
Required three to five (3 - 5) years of workers’ compensation supervisory responsibilities
Must meet all local regulatory licensing requirements

106

Business Workers Compensation Analyst Resume Examples & Samples

Analyze, review, forecast, and transform data
Present analysis and interpretation for colleagues and clients
Develop recommended business solutions through research and analysis of data and business process and implement when appropriate
Develop, build and manage databases containing workers' compensations fee schedule information
3+ years of experience data transformation and / or workers' compensation reimbursement
Experience gathering requirements from the client / business and documenting
SQL (1+ year)
Ability to communicate analysis including trends and opportunities to clients and the business in writing and verbally

107

Middle Market Workers Compensation Product Assistant Director Resume Examples & Samples

Bachelors Degree required; CPCU or other industry designation preferred
6 years minimum experience in Commercial P&C Underwriting or Claims is required; guaranteed cost workers’ compensation experience preferred
Understanding of both exposure and loss rating underwriting principles
Understanding of predictive modeling concepts preferred
Proficiency with Workers’ Compensation coverage preferred
Financial acumen – strong analytical skills and aptitude for numerical and/or financial evaluation of business performance
Ability to build strong relationships across an organization
Self-starter with a limited need for constant supervision
Proven track record of setting goals and delivering results
Strong executive presence and presentation skills required

108

Middle Market Workers Compensation Product Director Resume Examples & Samples

Bachelors Degree required; CPCU or other industry designation preferred
10 years minimum experience in Commercial P&C Underwriting or Claims experience required, guaranteed cost workers’ compensation experience preferred
Understanding of both exposure and loss rating underwriting principles
Understanding of predictive modeling concepts preferred
Proficiency with Workers’ Compensation coverage preferred
Financial acumen – strong analytical skills and aptitude for numerical and/or financial evaluation of business performance
Demonstrated competency in strategic thinking and leadership
Ability to build strong relationships across an organization
Self-starter with a limited need for constant supervision
Proven track record of setting goals and delivering results
Experience and comfort level communicating with individuals at all levels including ability to successfully make recommendations to Senior Leadership

109

Workers Compensation Claims Manager Resume Examples & Samples

Designs and implements the most effective claims management structure, controls, programs, staffing (internal and external), including the company’s litigation strategies
Supervises staff and vendors to ensure high performance in claims management
Monitor, evaluate, and audit third party claim adjusters, attorneys, and related vendors including financial management and control of vendor expense. Manage the selection, evaluation, and use of vendors, defense attorney, claims staff, and partners associated with the overall claims program and ensuring all service instructions are current
Identifies trends within claims program and drives process improvements
Supports internal partners and Risk Management Team through training and education meetings
Evaluates vendor effectiveness on ongoing basis
Provides input on casualty claim data to actuary to ensure proper analysis of ultimate losses
Identifies and implements the most effective claims staff structure to achieve the maximum impact on managing claims
Compiles data in support of Insurance Budget management and Long Range Planning analysis
Responsible for overseeing an annual WC loss budget in excess of $34 MM
Direct the workers compensation process by designing and implementing specific strategies to objectively reduce the cost and duration of employee injuries by working closely within AAP, third party workers’ compensation adjusters, insurance carrier(s), broker(s), managed care providers, defense attorneys, and the state regulatory agencies while maintaining full compliance with the various state workers compensation acts and regulations
Organize and direct workflow internally and externally with third party claims administrators, vendors, and defense attorneys to achieve efficient coordination, investigation, evaluation, and resolution of assigned claims
Ensure WC Claims internal audit controls are updated, managed and in compliance
Understands and supports the actuarial analysis process
Develop proactive training programs for all levels of Team Members and managers and related vendors as needed to impact the cost and duration of claims to enforce the effectiveness of the company’s post loss strategies, including AAPs return to work program and claim allocation charges & credits
Ensure compliance with all applicable policies, procedures, regulations and laws related to claims management functions. Stay abreast of legal, regulatory, and policy developments affecting areas of responsibility. Enforce legal and regulatory requirements impartially
Reviews internal and external loss detail reports provided by vendors, actuaries, & partners, analyze data and prepares trending reports. Utilize this information to identify key areas of concern, in coordination with the Director of Risk Services and the Director of Safety recommend strategies to reduce risk areas
Advanced degree a plus including ARM, AIC, or CPCU
Extensive knowledge of WC claims, regulations and procedures on a multi-state basis
Knowledge of insurance carriers & experience managing TPA’s is required
Prior supervisory experience in managing a claims program is required
Excellent communication and training skills required, in order to appropriately communicate with individuals of differing knowledge levels (e.g., Team Members, managers, customers, doctors, attorneys, senior management, etc.)
Ability to multi-task, prioritize and organize work to meet deadlines and multiple requests
Knowledge of medical terminology, occupational injuries, treatment protocols, and legal proceedings is required
Demonstrated ability to develop and direct corporate wide strategies and the ability to effectively manage third party vendors and partners is essential
Proficiency Excel, PowerPoint, Word and database software
Willingness to work flexible hours. Incumbent must be able to travel to diverse work locations

110

Workers Compensation Analyst Resume Examples & Samples

Graduation from college with a major in business administration, public administration, industrial psychology, or an allied field; or an equivalent combination of education and experience
Two to four (2 - 4) years of related experience in Workers Compensation
Experience with and advanced knowledge of California Workers Compensation Law
Experience with and extensive knowledge of University Workers' Compensation policies and procedures
Demonstrated experience with and knowledge of Risk Management principles
Proven ability to analyze and interpret policies, rules, laws and regulations
Demonstrated ability to analyze information and produce summaries and reports
Excellent written and verbal communication skills with the ability to interact effectively with a diverse group of professionals
Strong analytical and deductive reasoning skills
Proven ability to use initiative and to work independently exercising good judgment
Demonstrated ability to set priorities and resolve conflicting demands
Strong diplomatic skills and proven ability to maintain confidentiality
IEA Workers Compensation Claims Administration Certificate
Detailed knowledge of UCSD Policies and Procedures, University Business & Finance Bulletins, and UC Policies

111

Consultant Workers Compensation Resume Examples & Samples

Providing clients with strategic and operational solutions to their risk management needs
Providing National and State-based workers’ compensation claims and injury management support and advice
Working with clients and their insurer to strategically manage and actively close workers’ compensation claims
Actively promote the growth of the consulting practice by participating in Business Development activities
Compiling regular reporting in agreed formats for clients
Conducting outsourced return to work coordination and consulting support to key client programs
Ideally we are looking for someone with 3 – 5 years of experience in a similar Consulting/Claims environment, or working for an insurer or self-insurer, however applicants from various backgrounds will be considered
Qualifications in Injury Management, RTW or Bachelor Degree in either Allied Health or Human movement will be highly regarded
Excellent organisation and planning skills
Ability to work to strict deadlines are essential in this role
Strong communication, problem solving and influencing skills

112

Workers Compensation Supervisor Resume Examples & Samples

Oversees the handling of all aspects of the claims assigned to the unit including reserving, communication, documentation, litigation management, evaluation, negotiation and settlement
Participate in the specialized training and handling of complex claim matters and projects requiring advanced claim knowledge and experience
Manages the development and training of subordinates, including monitoring and relaying information to the staff regarding changes in coverage and laws
New York WC license a preferred
Sound command of the English language
High school graduate/GED; prefer college degree

113

Senior Workers Compensation Claims Representative Resume Examples & Samples

Perform timely and thorough investigations in an effort to comply with all jurisdictional requirements and/or entitlements
Conducts an informed case analysis to address claim entitlements. Initiate reserve changes within assigned authority, makes recommendations to supervisor or manger where assigned authority is exceeded
Manage, control and negotiate timely and equitable claim payments and settlements in accordance with jurisdictional and fair claims practices requirements and company policy and procedures
Investigate, evaluate and resolve moderate level litigated files including all aspects of litigation management in accordance with the Claims Handling Guidelines
Maintain current case diary and ensure appropriate file documentation.Responsible for completion and/or submission of claim forms and reports as required by outside agencies
Investigate and evaluate recovery potential. Conduct timely and thorough subrogation investigation in accordance with company policy and procedures. Timely completion and referral of all claims involving recovery potential
Service the claim needs of our customers, including insureds, claimants, brokers etc. in accordance with company policy and procedures
Bachelor's degree (B. A.) preferred; 5+ years related WC claims experience preferred Completion of insurance and/or claims courses preferred (IAA, AEI, CPCU) Knowledge of multi-state WC laws. Adjuster licenses will be required

114

Workers Compensation Supervisor Resume Examples & Samples

1+ year experience in Microsoft office
12+ years of experience in automotive workers’ compensation
5+ years of supervisory experience in automotive workers’ compensation

115

Claims Adjuster Workers Compensation Resume Examples & Samples

Calculates and assigns timely and appropriate reserves to claims; manages reserve adequacy throughout the life of the claim
Calculates and pays benefits due; approves and makes timely claim payments and adjustments; and settles clams within designated authority level
Prepares necessary state fillings within statutory limits
Manages claim recoveries, including but not limited to: subrogation, Second Injury Fund excess recoveries and Social Security and Medicare offsets
Communicates claim activity and processing with the claimant and the client; maintains professional client relationships

116

Manager Workers Compensation Resume Examples & Samples

Lead, manage, train and assist team of Crewmembers that provide world class service to the JetBlue Crewmembers who have been injured on the job
Track survey results; identify and address any negative trends
Develop goals and objectives with a clear definition of how success within the position can be achieved
Refine/develop communication and response protocols, including an empathic view and advocacy methodology between Workers’ Compensation Team and the Crewmembers
Refine/develop written tools / templates to facilitate communication processes with injured Crewmembers (e.g., explanation of OJI process, overview of benefits, role and expectations of all involved parties)
Involvement in all highly sensitive and/or catastrophic, high exposure claim matters
Define and prioritize service initiatives for the Workers’ Compensation Team to ensure expedited medical care and improved management of medical treatment
Provide a responsive, positive resolution of all raised service issues
Develop creative means to reduce disability duration
Provide various trending reports, identifying areas of opportunity for improvement and suggested remediation steps to Risk Manager
Provide reports as needed to internal stakeholders
Support all marketing exercises, to include requests for proposals (RFP’s), as necessary
Lead all Carrier / Claim Administrator Claim Reviews, and report back to Risk Manager any identified issues with resolution steps
Meet with internal stakeholders on a regular basis to better integrate communication. Develop strategies to collaboratively address Crewmember concerns
Maintain primary ownership over the claims management services provided by the Claim Administrator, directing best-in-class services for the primary benefit of injured Crewmembers, while maintaining vigilance over associated claim costs
Maintain a constructive partnership with brokerage claim advocacy and ensure alignment of responsibilities and goals
Develop and maintain relationship with all key vendors (e.g., managed care, pharmacy benefit manager, defense counsel, investigation firms, etc.), including negotiation of preferred rates and services
Remain up-to-date on current issues, enhanced resources and innovative Caring and cost reduction strategies
Ad hoc Worker’s Compensation related projects as they arise
Five (5) years of practical experience in Worker’s Compensation (Corporate, Insurer or Adjustor)
Three (3) years supervisory or management experience
Proficient with the Microsoft Office suite
Ten (10) years Worker’s Compensation experience
One (1) year supervisory or management experience
Proficient in ad hoc queries
Previous airline industry experience
Potential need to work flexible hours and be available to respond on short-notice
Well-groomed and able to maintain a professional appearance

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