Sr. Worker's Comp Specialist

Westchester Medical Center Health Network; Town of Mount Pleasant (NY); On-site; USD 70,000 - 110,000; Full time

Job summary

Westchester Medical Center Health Network seeks a Workers’ Compensation Specialist to independently investigate, evaluate, and resolve complex NY state claims under the direction of the Sr. Director of Leave Management.

The role manages cases from inception to closing, ensuring compliance with statutes, policy provisions, and organizational guidelines. Responsibilities include acting as subject matter expert, serving as primary contact for injured employees, coordinating with adjusters and

Qualifications

• Minimum of 5 years’ experience handling New York State workers’ compensation claims.
• Associates Degree required; Bachelor's degree preferred.
• Experience with regulatory compliance and claims processing.

Responsibilities

• Investigates and resolves complex NY workers’ compensation claims.
• Serves as primary contact for injured employees throughout the claim.
• Administers indemnity and medical benefits for valid claims.
• Provides guidance on claim management and settlement strategies.
• Maintains thorough documentation and diary for all claims.
• Coordinates with supervisors and adjusters to progress claims.
• Collaborates with risk management to optimize leave and claim processes.
• Ensures timely reporting to vendors or state agencies.

Skills

Microsoft Office

Time management

Organizational skills

Communication skills

Negotiation skills

Analytical thinking

Regulatory knowledge

Team collaboration

Education

Associates degree

Bachelor’s degree preferred

Tools

Spreadsheets

MS Excel

Job description

Job Summary : Under the direction of the Sr. Director of Leave Management, the Workers’ Compensation Specialist will utilize knowledge of Workers’ Compensation to independently investigate, evaluate and resolve assigned claims of a more complex nature in order to achieve appropriate outcomes. In this position the Specialist will manage and resolve Workers’ Compensation claims in a timely manner in accordance with legal statues, policy provisions, and organizational guidelines. In addition, the Workers’ Compensation Specialist will manage a caseload of claims from inception to closing or settlement.

Responsibilities

• Serves as the subject matter expert for workers’ compensations.
• Acts as the primary point of contact for each injured employee for the duration of their workers’ compensation claim; acts as liaison between injured employee and workers’ compensation adjuster; and follows up with injured employee as needed to ensure claim is progressing properly.
• Investigates claims to determine an injured worker’s entitlement to Workers’ Compensation benefits; administers indemnity and medical benefits for valid Workers’ Compensation claims.
• Provide advice and counsel regarding claims management, claim compensability and/or settlement strategies with Medline, TPAs, nurse case managers and defense attorneys.
• Responsible for receiving, organizing, and analyzing all files and documents related to the injured worker and the injury in order to make an effective and accurate determination concerning the claim.
• Performs interview with the injured employee to obtain a detailed description of how the injury occurred.
• Performs interview with the employee’s supervisor to verify the description of the incident and what could have been done to prevent the incident.
• Conducts investigations of alleged fraudulent activity of all leave cases and workers' compensation.
• Contacts the employee immediately following the initial medical treatment for diagnosis, prognosis, and expected period of disability, if any.
• Analyzes and processes workers’ compensation claims by investigating and gathering information to determine compensability and exposure.
• Ensure accurate and timely reporting of all workers’ compensation claims by all employees and management to the appropriate vendor or state agency.
• Reviews and maintains personal diary on claims.
• Maintains weekly telephone contact with the employee while off work and treating.
• Investigates, evaluates and strategizes on resolution of non-litigated matters.
• Compiles and reviews claim data; identifies risk exposures through evaluation of loss statistics and trends.
• Collaborates closely with the Workers’ Compensation Manager in developing business unit risk management strategies, placement, and management of Workers’ Compensation program for the Network
• Provide insightful and comprehensive risk management consulting services to business areas including return-to-work timelines, new acquisition compliance, lost time tracking, and safety reviews of work environments.
• Keeps Manager informed verbally and in writing of activities and problems within assigned area of responsibility; refers matters beyond limits of authority and expertise to Manager for direction.
• Reports claims to the excess carrier when applicable.
• Coordinates return to work (RTW) and sets target dates.
• Documents files in the Leave Management systems.
• Effective and timely coordination of communication with supervisors/managers, claimants and other appropriate parties throughout the claim process.
• Perform other duties as assigned or required.

Qualifications/Requirements

Experience: Minimum of 5 years’ experience handling New York State workers’ compensation claims.

Education: Associates Degree, required. Bachelor’s Degree, preferred.

Special Requirements

• Proficiency in Microsoft Office applications and familiarity with necessary tools such as spreadsheets.
• Strong organizational skills and demonstrated ability to prioritize work.
• Good time management skills to investigate and give a report on claims within a given time frame.
• Ability to lead and work effectively and collaboratively within team settings and build partnerships both internal and external.
• Effective deliberation and negotiating skills resulting in successful outcomes.
• Analytical thinking and particular attention to detail which enables to strategically handle investigations and tactically tackle issues.
• Adequate knowledge of relevant regulations and policies and procedures.
• Excellent verbal and written communication skills to effectively communicate with co-workers, supervisors and managers.