Workers' Compensation Claims Analyst - Hybrid

University of Illinois System; Urbana (IL); Hybrid; USD 55,000 - 60,000; Full time

Job summary

The University of Illinois System's UIUC Claims Management seeks a Workers' Compensation Claims Analyst to minimize financial losses by promptly identifying, investigating, analyzing, and recommending dispositions of workers' compensation claims. This hybrid, full-time role engages with University staff to implement loss control programs.

The analyst will conduct in-depth investigations, approve medical treatments, manage reserves, prepare reports, coordinate with outside counsel, and present

Qualifications

• Bachelor's degree required.
• Experience in workers' compensation claims administration preferred.
• Strong analytical and investigative abilities.

Responsibilities

• Investigate claims with in-depth analysis and collect evidentiary materials.
• Analyze documentation, determine medical treatment approvals, reserves, and referrals.
• Prepare written investigative reports with witness interviews.
• Consult with outside counsel and review bills before authorization.
• Summarize allegations and analysis with a recommended defense strategy.
• Assist in settlements when warranted and monitor progress.
• Deliver lectures on claim prevention and loss management.
• Coordinate with faculty, staff, counsel, risk managers on settlements and return-to-work.
• Perform other duties as needed.

Skills

Verbal communication

Written communication

Discretion

Judgment

Claim reporting

Education

Bachelor's degree

Job description

Workers' Compensation Claims Analyst - Hybrid

UIUC Claims Management

Hybrid

The primary function of this position is to minimize financial losses against the University of Illinois and its employees by the prompt identification, investigation, analysis, and recommendation for disposition of workers' compensation claims. The Workers' Compensation Claims Specialist interacts with University staff to implement appropriate loss control programs or procedures designed to mitigate the frequency and severity of such losses.

Responsibilities

• Investigate claims as instructed by the Sr Associate Director by conducting in-depth investigations into allegations against the University and/or its employees of any potentially compensable workers' compensation events, e.g., occupational injury and/or occupational disease claims. Secure all potential evidentiary materials such as the accident report, medical records, X-ray films, photographs, and statements to justify accepting the compensability of the claim. Input claim information as needed into the database, including use of a diary system and comprehensive notes regarding claim status. (20%)
• Perform a detailed claims analysis. Analyze all documentation in order to approve appropriate medical treatment, establish initial case reserves and subsequent updates, and make referrals for nurse case management/vocational rehabilitation/utilization and peer review as needed. Identify potential Medicare considerations and understand Medicare's interest in Workers' Compensation cases. Authorize medical and temporary total disability payments on approved claims. 20%
• Prepare a written investigative report which includes interviews with all witnesses, co-workers, supervisors, medical practitioners, and others involved in the claim. Consultation with experts and medical and legal research may be required. 15%
• Consult with outside legal counsel in furtherance of the legal defense of the University, its staff and other employees. Review outside counsel legal bills for appropriateness and accuracy before authorizing funds expenditure. 10%
• Prepare a written summary of allegations and analysis of each claim, focusing on the weaknesses and strengths of the University's position. A crucial element of the summary is a recommendation for a positive defense strategy to be presented to the Workers' Compensation Review Committee for review and reserving of funds. 10%
• As needed, settle claims if investigation reveals the claim is compensable, and the injury/illness justifies payment of a permanent settlement. Monitor and periodically review assigned cases with the Sr Associate Director in order to maintain continued evaluation and assessment of the progress of claims. 5%
• Design, develop, and deliver lectures and presentations to promote the concepts of claim prevention and management as well as transitional work provisions; make units aware of their loss history and how practices have contributed to loss liability for the University; and provide information on how departments can reduce their claim frequency and severity. Provide orientation sessions and materials to University staff on University Workers' Compensation Claims policy and procedures. 5%
• Interface closely with faculty, staff, and injured parties; University Counsel; outside counsel; University Risk Manager; Campus Risk Manager; medical representatives; University Housing and Operations and Maintenance personnel with regard to settlement discussions, return-to-work programs; and light duty programs. 10%
• Other duties and responsibilities appropriate for a Workers' Compensation Claims Specialist position. 5%

Specialty Factor

• Bachelor's degree.
• A total of one (1) year (12 months) in education, training and/or work experience in workers' compensation claims administration, including claims investigation, analysis, case management, and/or resolution. (Note: A Master's Degree in an area consistent with the duties of the position may be substituted for one (1) year of work experience.)

Preferred

• Two years demonstrated experience in one or more of the following areas: insurance, risk management, workers' compensation, group insurance, healthcare, or liability claims.
• Basic legal knowledge in the area of Illinois Workers' Compensation, including an understanding of Medicare considerations related to workers' compensation claims.

Knowledge Skills And Abilities

• Very strong verbal and written communication skills.
• Ability to recognize the delicate and sensitive nature of information.
• An understanding of the importance of maintaining discretion and confidentiality of information at all times.
• Ability to use independent judgment in determining the weaknesses and strengths upon which the University's defense may be based.
• Solid experience preparing claim reports and summaries.
• Ability to use critical thinking in order to make decisions as to the relative importance of various medical facts and circumstances surrounding workers' compensation claims.
• Excellent keyboarding, grammar, and proofreading skills, with strong emphasis on accuracy and applicable formats and criteria, to prepare and process correspondence, reports, and other documents that appropriately reflect University and department standards.
• Travel may be necessary.

Appointment Information

This is a 100% Full Time Civil Service Program Coordinator position. The expected start date is as soon as possible. Sponsorship for work authorization is not available for this position.

System Office jobs such as this one are not eligible for the Referral Program.

The budgeted salary range for the position is $55,000.00 - 60,000.00. Salary is competitive and commensurate with qualifications and experience, while also considering internal equity.

This position is intended to be eligible for benefits . This includes Health, Dental, Vision, Life Insurance, a Retirement Plan, Paid time Off, and Tuition waivers for employees and dependents.

Campus Location: Urbana

Contact Information

System Human Resource Services

[phone]

[e-mail]

Equal Opportunity Employer

The University of Illinois System is an equal opportunity employer, including but not limited to disability and/or veteran status, and complies with all applicable state and federal employment mandates. Please visit Required Employment Notices and Posters to view our non-discrimination statement and find additional information about required background checks, sexual harassment/misconduct disclosures, and employment eligibility review through E-Verify.

Applicants with disabilities are encouraged to apply and may request a reasonable accommodation under the Americans with Disabilities Act (2008) to complete the application and/or interview process. Requests may be submitted through the reasonable accommodations portal, or by contacting the System Human Resource Services at 217-333-2600, or by emailing [e-mail] .