Sr. Workers Compensation Specialist

BJC HealthCare (New); Northern (KY); Hybrid; USD 70,000 - 95,000; Full time

Benefits offered by this job

Medical, dental, vision, life coverage

401(k) plan with company match

Tuition assistance

Paid time off

Job summary

BJC HealthCare is seeking a Sr. Worker's Compensation Specialist for a remote role. The position manages workers' compensation and employee injury cases from initial report through final resolution, overseeing the full lifecycle of each claim from investigation to settlement.

Ideal candidates should be familiar with Missouri and Illinois workers' compensation regulations and possess strong analytical and negotiation skills to support Occupational Health, Leave/ADA, and Corporate Legal teams.

Qualifications

• Experience processing workers' compensation claims and managing claims lifecycle.
• Familiarity with state workers' compensation regulations and reporting requirements.
• Strong analytical, negotiation and stakeholder communication skills.

Responsibilities

• Process workers’ compensation claims from initial report to final resolution, including investigations and settlements.
• Determine compensability, coordinate medical treatment, and manage reserves within authority.
• Provide SME support to Occupational Health, Leave/ADA, and Corporate Legal on workers’ compensation implications.

Skills

Workers' compensation knowledge

Regulatory compliance

Investigation and negotiation

Education

High School Diploma or GED

Bachelor's Degree - Business

Job description

Additional Information About the Role

BJC Health has a remote opportunity for a Sr. Worker's Compensation Specialist to join the team. This position manages workers' compensation and employee injury cases from initial report through final resolution, overseeing the full lifecycle of each claim from investigation to settlement.

Ideal candidates should be familiar with Missouri and Illinois works compensation regulations.

Overview

BJC HealthCare is one of the largest nonprofit health care organizations in the United States, delivering services to residents primarily in the greater St. Louis, southern Illinois and southeast Missouri regions. With net revenues of $6.3billion and more than 30,000 employees, BJC serves patients and their families in urban, suburban and rural communities through its 14hospitals and multiple community health locations. Services include inpatient and outpatient care, primary care, community health and wellness, workplace health, home health, community mental health, rehabilitation, long-term care and hospice.

BJC is the largest provider of charity care, unreimbursed care and community benefits in the state of Missouri. BJC and its hospitals and health service organizations provide $785.9 million annually in community benefit. That includes $410.6 million in charity care and other financial assistance to patients to ensure medical care regardless of their ability to pay. In addition, BJC provides additional community benefits through commitments to research, emergency preparedness, regional health care safety net services, health literacy, community outreach and community health programs and regional economic development.

BJC's patients have access to the latest advances in medical science and technology through a formal affiliation between Barnes-Jewish Hospital and St. Louis Children’s Hospital with the renowned Washington University School of Medicine, which consistently ranks among the top medical schools in the country.

Preferred Qualifications

Role Purpose

Process all BJC workers' compensation claims using the latest technology to review, analyze and process complex cases within assigned authority limits. This includes making automomous decisions within their authority regarding compensability, evaluating losses, coordinating medical treatment, within jurisdictional guidelines, negotiating settlements, and being subject matter experts to BJC.

Responsibilities

• Continued Education in all legal changes in the workers’ compensation laws for jurisdictions being handled. Stay updated in changes and procedures in the medical treatment of work-related injuries both physical and mental. Must be familiar with legal and medical terminology along with legal required filing dates and procedures.
• Process workers’ compensation claims. Determine compensability, investigations, coordinate medical treatment, within jurisdictional guidelines, direct our outside attorney firms, negotiate settlements, assure cases are reserved for adequate financial exposure per state requirements. Participate in Arbitration, Mediations, and Trials to bring the cases to final resolution. Review medical and panels with Manager. Be a resource for Case Coordinators and Occupational Health.
• Serve as a subject matter expert. Provide Occupational Health department, BJC Leave/ADA, and BJC Corporate Legal support regarding any implication’s workers’ compensation may have in their areas. Develop training programs for BJC employees, Management and Occupational Health to better understand the rights and processes of workers’ compensation.
• Maintain adequate financial reserves on each claim and coordinate the legal activities associated with assigned cases. Establish adequate reserves on each file to support the probable outcome of the file based on the facts at the time of review within their authority. These are required to ensure that BJC can maintain their self-insured status within Missouri and Illinois. These financials are also used to develop BJC’s exposure for the actuarial review for the financial strength of BJC. Provide direction and oversite to the partnered law firms to bring timely and cost- effective resolutions, and assure the firms are working with in the established guideline within their authority levels. Request approval for all reserves and settlement authority above their authority. Attend Arbitration, Mediations, and Trials when needed.
• Report and coordinate with BJC's Reinsurance carrier any claims meeting the reporting requirements. Send initial notice of specific cases per the policy when they occur and within the designated time requirements. Provide follow up and sequential reporting as needed.

Minimum Requirements

Education

• High School Diploma or GED

Experience

• 2-5 years

Supervisor Experience

• No Experience

Preferred Requirements

Education

• Bachelor's Degree

- Business

Experience

• 5-10 years

Benefits and Legal Statement

BJC Total Rewards

At BJC we're committed to providing you and your family with benefits and resources to help you manage your physical, emotional, social and financial well-being.

• Comprehensive medical, dental, vison, life insurance, and legal services available first day of the month after hire date
• Disability insurance* paid for by BJC
• Annual 4% BJC Automatic Retirement Contribution
• 401(k) plan with BJC match
• Tuition Assistance available on first day
• BJC Institute for Learning and Development
• Health Care and Dependent Care Flexible Spending Accounts
• Paid Time Off benefit combines vacation, sick days, holidays and personal time
• Adoption assistance

Benefits Summary

*Not all benefits apply to all jobs

The above information on this description has been designed to indicate the general nature and level of work performed by employees in this position. It is not designed to contain or be interpreted as an exhaustive list of all responsibilities, duties and qualifications required of employees assigned to this job. Equal Opportunity Employer