What are the responsibilities and job description for the Claims Review Specialist position at Aston Carter?
Job Summary:
Reporting to the Workers Compensation Compliance Supervisor and Workers Compensation Compliance Manager, the Claims Review Specialist will assist in the monitoring and administering of workers compensation program to ensure the maximum cost containment. Seek to ensure that Third Party Administrator (TPA) is managing claims efficiently.
Essential Functions:
• Conducts and properly document all incident /accident investigations into our RIMIS system. Ensures the TPA thoroughly and properly investigates all initial claims. Monitor to ensure that TPA follows appropriate state workers compensation laws and defenses
• Within the scope of authority, reviews and authorizes worker’s compensation settlement offers to be made by the TPA
• Effectively monitors medical and disability claim authorizations and payments to ensure their appropriate and accurate
• Reviews costs associated with all claims handling and developing strategies to improve performance
• Works with TPA to move claims toward closure
• Partners with Safety, Human Resources and Corporate Legal to drive claims management
• Makes appropriate referrals to outside vendors such as defense attorneys, nurse case managers and investigator
• Coordinates the employee’s release to transitional duty with the Return-to-Work Specialist and the Field Office.
• Obtains evidence in contested and/or litigated claims to assist outside attorneys to defend claim and to prepare for trial
• Initiate subrogation where appropriate with management’s authorization
• Prepares for and attends Claim Review Conference with TPA to evaluate individual cases; reviews, and adjusts financial reserves of claims; negotiates with TPA the settlement of claims within established authority and work together to develop detailed and doable Plans of Actions
• Conducts bi-annual audits to ensure TPA is meeting their best practices requirements
• Review reserves and provide authorization to TPA, where appropriate within authority
• Reviews performance of external vendors in the areas of claims administration, manages litigation and make recommendation to Workers Compensation Compliance Supervisor for adjustments
• Monitors and reviews workers compensation claims and the claims processing; identifies claims management trends and inefficiencies and make recommendation as needed
• Participates in developing strategies to reduce claims frequency and severity
• Establishes and maintains a file and diary on all open claims
• Participates in communicating claims trends to Regional Safety Manager
• Working with Compliance Supervisor to develop and conduct training to field offices regarding workers compensation issues and process
• Attends training sessions, conferences, and workshops to keep abreast of current practices, programs and legal issues for the purpose of conveying and/or gathering information required to perform functions
4 days in office, 1 day WFH (Friday)
About Aston Carter:
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At Aston Carter, we’re dedicated to expanding career opportunities for the skilled professionals who power our business. Our success is driven by the talented, motivated people who join our team across a range of positions – from recruiting, sales and delivery to corporate roles. As part of our team, employees have the opportunity for long-term career success, where hard work is rewarded and the potential for growth is limitless.
Established in 1997, Aston Carter is a leading staffing and consulting firm, providing high-caliber talent and premium services to more than 7,000 companies across North America. Spanning four continents and more than 200 offices, we extend our clients’ capabilities by seeking solvers and delivering solutions to address today’s workforce challenges. For organizations looking for innovative solutions shaped by critical-thinking professionals, visit AstonCarter.com. Aston Carter is a company within Allegis Group, a global leader in talent solutions.
The company is an equal opportunity employer and will consider all applications without regards to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.
If you would like to request a reasonable accommodation, such as the modification or adjustment of the job application process or interviewing process due to a disability, please call 888-237-6835 or email astoncarteraccommodation@astoncarter.com for other accommodation options. However, if you have questions about this position, please contact the Recruiter located at the bottom of the job posting. The Recruiter is the sole point of contact for questions about this position.
Salary : $28 - $33
