Advocate Aurora Health · 2 months ago
Workers Compensation Claims Analyst
Carolinas Medical Center - 1000 Blythe Blvd, Charlotte, NC
Full-time
Hybrid
Mid, Senior Level
$30.15/hr - $45.25/hr
2+ years expAdvocate Aurora Health is the third-largest nonprofit, integrated health system in the United States, and they are seeking a Workers Compensation Claims Analyst. The role involves managing claims, adjudicating medical only claims, and negotiating settlements while ensuring compliance with workers’ compensation regulations across multiple jurisdictions.
Health Care
Responsibilities
Must possess analytical skills and be able to work with a sense of urgency and accuracy. Must be able to adhere to multiple state workers’ compensation rules, regulations, and laws
Must be able to complete appropriate contacts within 24 hours of assignment, establish and maintain appropriate diary for follow-up, evaluates and determines compensability of workers’ compensation claims within the statutory period for multiple jurisdictions
Must be able to be responsible for monitoring and controlling costs, timely documentation of the electronic claim file, claim outcome, timely reserving of files, managing subrogation and litigation, filing appropriate forms and payment of all benefits due within statutory periods and coordinates light duty as needed
Must function as a resource to the injured teammates, leaders, and others with an interest in the claim
Must be able to communicate claim status with the injured teammate and other parties, as necessary
Must be able to develop action plans and strategies for prompt payment/denial of claims bringing them to a timely conclusion while providing all appropriate information. Must be able to monitor and report appropriate claims to excess carriers
Must be able to determine what treatment is appropriate and causally related to the compensable injury and redirect treatment to network physicians as appropriate. Must be able to promptly authorize and approve related expenses of the claim
Must be able to maintain strict confidentiality of information at all times of a sensitive nature and/or protected under state and federal law
Must be able to develop and maintain professional customer relationships. Must be able to provide education as needed and serve as a mentor to other adjusters and stakeholders
Must be able to provide additional support for additional projects and duties as assigned
Qualification
Required
Must possess analytical skills and be able to work with a sense of urgency and accuracy
Must be able to adhere to multiple state workers' compensation rules, regulations, and laws
Must be able to complete appropriate contacts within 24 hours of assignment
Establish and maintain appropriate diary for follow-up
Evaluates and determines compensability of workers' compensation claims within the statutory period for multiple jurisdictions
Must be responsible for monitoring and controlling costs
Timely documentation of the electronic claim file, claim outcome, timely reserving of files
Managing subrogation and litigation
Filing appropriate forms and payment of all benefits due within statutory periods
Coordinates light duty as needed
Must function as a resource to the injured teammates, leaders, and others with an interest in the claim
Must be able to communicate claim status with the injured teammate and other parties, as necessary
Must be able to develop action plans and strategies for prompt payment/denial of claims bringing them to a timely conclusion while providing all appropriate information
Must be able to monitor and report appropriate claims to excess carriers
Must be able to determine what treatment is appropriate and causally related to the compensable injury
Must be able to promptly authorize and approve related expenses of the claim
Must be able to maintain strict confidentiality of information at all times of a sensitive nature and/or protected under state and federal law
Must be able to develop and maintain professional customer relationships
Must be able to provide education as needed and serve as a mentor to other adjusters and stakeholders
Must be able to provide additional support for additional projects and duties as assigned
Adjusters license for assigned jurisdiction as required by specific jurisdiction as applicable
Bachelor's degree required or a combination of education and related experience
2-5+ years' experience managing progressively difficult Workers Compensation lost time claims
Must be competent in workers' compensation rules, regulations, and laws for multiple jurisdictions
Must work with a sense of urgency and accuracy
Evaluates and determines compensability of workers' compensation claims within the statutory limits for multiple jurisdictions
Must be able to work independently as well as part of a team
Access to protected Health Information (PHI) to the extent of information necessary to do the job
Preferred
Associates in Claims designation preferred
Benefits
Paid Time Off programs
Health and welfare benefits such as medical, dental, vision, life, and Short- and Long-Term Disability
Flexible Spending Accounts for eligible health care and dependent care expenses
Family benefits such as adoption assistance and paid parental leave
Defined contribution retirement plans with employer match and other financial wellness programs
Educational Assistance Program
Company
Advocate Aurora Health
Advocate Aurora Health is a Healthcare
10001+ employees
Funding
Current Stage
Late StageTotal Funding
$10.17MKey Investors
National Cancer Institute
2022-12-02Acquired
2019-08-20Grant· $10.17M
Leadership Team
Don Fosen - CISM, HCISPP
Chief Technology Officer
Jon Kluge
Chief Operating Officer, Senior Vice President, Advocate Aurora Medical Group
Recent News
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