Details
Posted: 27-Sep-24
Location: Tampa, Florida
Type: Full Time
Salary: Range varies by location
Categories:
Claims Management
Client Services
Workers Compensation
Certification Status:
N/A
Salary Details:
Ideally, we need one employee based in California. However, both positions can be remote and there is flexibility in the employee's location.
Preferred Education:
2 Year Degree
Additional Information:
2 openings available.
Telecommuting is allowed.
Internal Number: 2024-18272 & 2024-18270
Job SUMMARY
This position is responsible for coordinating the Company's Workers Compensation claims handling.
Job RESPONSIBILITIES
Claims Management:
- Ensure proper injury reporting procedures are followed, including medical management and claim investigation.
- Contact associates to address concerns, explain the role of the Insurance Carrier (IC), and provide ongoing support.
- Obtain and review diagnosis, treatment plans, and work status; coordinate return-to-work efforts with managers and HR.
- Enter claim details into Origami and forward relevant information to Broadspire.
- Review and approve initial claim reserves; recommend adjustments as necessary.
- Ensure adjusters are monitoring claims regularly, communicating with medical providers, and updating reserves as needed.
- Escalate issues if adjusters fail to monitor claims or reserves adequately.
Litigation and Settlement:
- Instruct adjusters on defense counsel for litigated claims and ensure files have updated plans of action with corresponding reserves.
- Evaluate settlement authority requests, ensuring they are well-supported and justified.
- Oversee claims until resolution, including medical treatment, financial recommendations, and risk mitigation.
Communication and Reporting:
- Maintain ongoing communication with the Primo management team and third-party insurers.
- Participate in mediations and hearings as required.
- Provide regular updates on claim status and review monthly claim activity for accuracy and completeness.
- Facilitate strategy sessions and ensure effective communication between all parties involved.
Data and Process Management
- Perform ongoing data reconciliation in Origami and review quarterly claims with the TPA.
- Approve pre-fund requests and ensure accurate reserve management.
- Collaborate with the Safety team to report and address unsafe or ergonomic challenges.
- Bachelor's degree or equivalent work experience
- Two to three years' experience in Claims Management and/or Workers' Compensation
- Proficiency in using insurance carrier/TPA data and claims management systems
- Strong understanding of technical claims procedures, medical protocols, and industry best practices
- Excellent critical thinking, analytical, and interpretive skills
- Ability to convey complex information clearly and professionally
- Proven ability to work effectively under pressure with minimal supervision and within strict guidelines
- Strong time management, multi-tasking, project management, and organizational skills
- Well-versed in applicable state workers' compensation laws
- Demonstrated sense of urgency, trust, confidentiality, and collaboration with all levels of the organization
- Good interpersonal skills and ability to work within a team environment
- Bilingual preferred
https://Jobbank.RIMS.org/jobs/20625894/injury-counselor