Our Houston, TX client, located in the Galleria of Houston, is in need of a Workers Compensation Claims Analyst.
Job Summary:
Manage a portfolio of Workers Compensation claims providing efficient, effective, and reliable claims services, and ensuring timely resolution. Will need to understands all aspects of company insurance program relating to coverage, state fund participation and self-insured status, Managed Care Organizations, deductibles and self-retentions
Principal Duties and Responsibilities:
Conduct and coordinate loss investigations on all assigned claims to provide accurate facts for disposition
Evaluate and negotiate the resolution of claims, while mitigating damages, to achieve cost effective claim outcomes
Negotiate the settlement of assigned claims within authorized amounts or specific file authority to produce appropriate outcomes
Review reserves on all assigned claim files and recommend changes where necessary to ensure actuarial accuracy
Effectively manages the workers compensation claims process by assessing, planning, implementing, monitoring, and evaluating each claim or case.
Monitors third party administrators, maintains periodic reviews of all types of claims including, serious vocational rehabilitation, questionable and sensitive claims.
Determines the severity of injuries, extent of disability, treatment plans, functional abilities and physical job requirements to establish target return to work plans and/or strategy to manage future medical exposure
Establishes appropriate reserves to reflect claim exposure.
Proactively manages lost time and medical expenses to achieve appropriate claim outcomes.
Facilitates earliest appropriate return to work release and coordinates return to work efforts with all parties as appropriate.
Works with medical providers and gives necessary information to facilitate a return to work plan on claims requiring disability management.
Obtains job description and discusses job modifications required to ensure a prompt return to work.
Pursues all claim resolution opportunities, (i.e.) return to work, structured settlement, and discontinuance of benefits through litigation within settlement authority or seeks additional settlement authority from management.
Ensures apportionments, subrogation, and Second Injury Fund opportunities are explored to reduce costs.
Monitors, analyzes and evaluates medical review process for efficiency, quality and cost reduction opportunities.
Manage claim strategy including written policies and procedures for claims reporting and handling, and other initiatives.
Update claim status
Performs other duties as assigned.
Education:
Bachelor degree or equivalent experience;
Requirements:
3 or more years Workers Compensation claims management and
5 or more years Workers Compensation claims adjusting experience
Please visit us on the web at www.frontlinesourcegroup.com
INTERESTED? CLICK HERE TO APPLY!
Equal Opportunity Employer, M/F/V/D. Candidates must have authorization to work in the U.S. Clients will not sponsor visas.
Frontline Source Group™ is one of the fastest growing Information Technology, Accounting, Legal, Human Resources, Administrative, and Clerical staffing and direct hire firms with offices throughout Texas (Arlington, Austin, Dallas, Fort Worth, Plano, Houston Galleria, Lewisville, West Houston, San Antonio, Sugar Land, and The Woodlands), Tennessee (Nashville and Brentwood), and Arizona (Phoenix and Scottsdale).
Frontline specializes in matching top talent with companies for direct, contract, and contract-to-hire placements. We work with clients and candidates in all areas of the United States and Canada.