Workers' Compensation Claims Analyst - Hybrid

Experience Champaign Urbana; Urbana (IL); On-site; USD 50,000 - 80,000; Full time

Job summary

Experience Champaign Urbana is seeking a Workers' Compensation Claims Specialist to investigate and manage claims filed by University employees. The role involves examining allegations, securing medical records, accident reports, and other evidence to determine compensability and to prepare detailed case notes.

You will input data, perform claims analysis, authorize payments, and coordinate with medical, legal and risk teams.

Job description

• 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%