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Fashion Nova · 5 days ago

Leave of Absence Specialist

Santa Fe Springs,CA

Full-time

Onsite

Senior Level

5+ years exp

Fashion Nova is an inclusive fashion-forward apparel and lifestyle brand that celebrates confidence. The Leave of Absence Specialist will manage the Workers’ Compensation program, ensuring effective claim resolution and collaboration with various stakeholders.

E-CommerceFashion

Responsibilities

Analyzes and processes complex or technically difficult workers' compensation 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 assigns timely and appropriate reserves to claims

Manages reserve adequacy throughout the life of the claim, providing Finance with monthly updates

Prepares necessary state fillings within statutory limits

Manages the litigation process; ensures timely and cost-effective claims resolution

Coordinates vendor referrals for additional investigation and/or litigation management

Uses appropriate cost containment techniques including strategic vendor partnerships to reduce overall cost of claims

Manages claim recoveries, including but not limited to, subrogation, Second Injury Fund excess recoveries and Social Security and Medicare offsets

Reports claims to the excess carrier; responds to requests of directions in a professional and timely manner

Communicates claim activity and processing with the claimant and Leadership; maintains professional client relationships

Ensures claim files are properly documented and claims coding is correct

Refers cases as appropriate to supervisor and management

Partners with multiple departments to coordinate and supervise the Return-to-Work program for team members to ensure work restrictions and transitional work guidelines are being adhered to

Availability and|or work evenings and weekends as dictated by business needs

Qualification

Workers' Compensation ClaimsInsurance PrinciplesNegotiation SkillsGoogle SuiteFraud InvestigationsMedical TerminologyAnalytical SkillsOrganizational SkillsInterpersonal SkillsTeamworkPresentation SkillsProblem Solving

Required

Five plus years of experience processing lost time workers' compensation claims, preferably for an employer with a high-deductible program

Bachelor's degree in Business Administration or Finance

Subject matter expert 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 procedures as applicable to line-of-business

Excellent oral and written communication, including exceptional presentation skills

Advanced knowledge of Google Suite

Knowledge of medical terminology

Analytical and interpretive skills

Strong organizational skills

Good interpersonal skills

Excellent negotiation skills

Ability to work in a team environment

Ability to meet or exceed Service Expectations

Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines