Workers' Compensation Claims Analyst - Hybrid

Csod; Urbana (IL); Hybrid; USD 55,000 - 60,000; Full time

Benefits offered by this job

Health insurance

Dental insurance

Vision insurance

Life Insurance

Retirement plan

Paid time Off

Tuition waivers

Job summary

University of Illinois System is seeking a Hybrid Workers' Compensation Claims Analyst to minimize financial losses by investigating and analyzing workers' compensation claims. The role interfaces with University staff to implement loss-control procedures and supports defense strategies with detailed reporting and expert consultations.

The position emphasizes strong communication, discretion, and independent judgment in evaluating claim weaknesses and strengths, with duties spanning

Qualifications

• One year (12 months) in workers' compensation claims administration or related work experience required.
• Master's Degree may substitute for one year of experience.

Responsibilities

• Investigate claims, collect evidence, and document status in the system.
• Analyze documentation to approve medical treatment and set reserves.
• Prepare investigative reports with witness interviews and expert input.
• Consult with outside counsel on defense strategy and review legal bills.
• Summarize allegations and analysis with recommended defense approach.

Skills

Investigative interviewing

Claims analysis

Legal coordination

Verbal and written communication

Job description

Workers' Compensation Claims Analyst - Hybrid

Workers' Compensation Claims Analyst - Hybrid

Posting Category:

Sponsorship for work authorization is not available for this position.

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.

DUTIES AND 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:

• 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.

• 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 TimeCivil Service Program Coordinatorposition. 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 .

• Health
• Dental
• Vision
• Life Insurance
• a Retirement Plan
• Paid time Off
• Tuition waivers for employees and dependents

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] .

Requisition ID: 9001021
Job Category: Civil Service
Campus Location: Urbana

Looking for more University of Illinois positions?

We invite you to search for positions at each of the University of Illinois' Universities and the University of Illinois System Office. The University of Illinois Foundation is the official fundraising and private gift-receiving agency for the University of Illinois and also offers position in all locations. Click the links below to search for other University of Illinois positions.

Employment Notices - View Federal and State notices related to employment at the University of Illinois System. Offers of employment by the University of Illinois System may be subject to approval by the University’s Board of Trustees and are made contingent upon the candidate’s successful completion of any criminal background checks and other pre-employment assessments that may be required for the position being offered. Additional information regarding such pre-employment checks and assessments may be provided as applicable during the hiring process.

The University of Illinois may conduct background checks on all job candidates upon acceptance of a contingent offer. Background checks will be performed in compliance with the Fair Credit Reporting Act. The University of Illinois System requires candidates selected for hire to disclose any documented finding of sexual misconduct or sexual harassment and to authorize inquiries to current and former employers regarding findings of sexual misconduct or sexual harassment. For more information, visit System Human Resource Services website. As a qualifying federal contractor, the University of Illinois System uses E-Verify to verify employment eligibility .