Corporate Claims Analyst | Work Comp Insurance

Corporate Claims Analyst - Work Comp Insurance | 100% Remote (WFH) Opportunity General Summary With little or no oversight, the Corporate Claims Analyst is responsible for reviewing, directing, overseeing, and consulting with claims staff on the management of catastrophic, large loss, and technically complex high dollar workers compensation claims. Essential Duties and Responsibilities

• Responsible for independent oversight of complex, catastrophic and high exposure cases. Independently review information, analyze case facts, apply appropriate statutes and regulations, and develop actionable claim resolution strategies. Consult and/or direct claims staff to ensure that appropriate, timely, proactive resolution strategies are implemented and followed.
• Manages Reinsurance Reporting processes by working closely with our reinsurance partners externally, as well as the Claim's Department internally, to ensure all claims eligible for reinsurance reporting are reported timely. Review Serious New Loss Reports and determine reinsurance reporting needs; including weekly reporting to reinsurance partner. Review, edit, compile, and submit reinsurance reports monthly. Ensure work items are addressed by adjusters and future work items are appropriate. Coordinate reporting activities with finance and/or legal as needed. Participate in the annual auditing of processes and applicable claim files. Responsible for maintenance and updating of the reinsurance P&G.
• Conduct comprehensive regulatory and internal claim audits to ensure compliance with industry standards and internal policies. Identify discrepancies and areas for improvement. perform preliminary analysis to identify discrepancies, collaborate with cross-functional teams to address findings, and contribute to the development of corrective action plans to ensure compliance.
• Direct and approve Medicare set-aside agreements prior to any settlement. Provide guidance to claim staff on Medicare protocols, reporting requirements and impact to the claim settlement. Works with CMS assigned agent/Medicare Counsel to ensure that conditional payment liens are handled accurately.
• Provide guidance and training to defense attorneys regarding Employers preferred handling of settlements involving an MSA and the usage of all addendums.
• Responsible for identifying training needs, designing, and delivering training and collaborating with auditors to evaluate the effectiveness. Develop instructional materials and reference materials in conjunction with claims management.
• Assist with or manage litigation as required. To include but not limited to, management and oversight of EL claims and possibly excess claims.
• Follow assigned claims medical treatment closely to ensure treatment protocols are current and appropriate for the injury type and severity.
• Independently analyze case facts to establish accurate case reserves utilizing extensive knowledge of medical disability costs and judgment on the extent of disability. Routinely review on-file case reserves and consult/mentor claim staff to mitigate differences when exposure difference is greater than 5%.
• Present files to the Chief Claims Officer, Actuary, and other senior executives at large loss meetings as required.
• Maintain active work items to ensure day to day knowledge of assigned caseload.
• Keeps abreast of regulatory changes, CMS updates and maintain technical expertise in applicable states.
• Develops and maintains professional customer relationships and communicates information accurately, clearly and completely.
• Other duties as assigned.

Requirements

• Minimum ten (10) years of experience handling Workers' Compensation Insurance claims.
• Experience managing catastrophic/large loss exposure claims.
• Experience and proficiency in litigation resolution, including Medicare set-aside agreements as well as expertise in coverage determinations, subrogation, and reinsurance.
• Technical knowledge of multiple states Workers Compensation laws, particularly in states in which we have business, is preferred.
• Able to quickly identify problems and develop solutions.
• Demonstrated ability to take the lead on issues and achieve results.
• Experience with report preparation and presentation to Executive level management.
• Able to clearly articulate technical issues to Senior Management.
• Ability to maintain a professional demeanor, even in difficult situations.
• Ability to maintain confidentiality is required.
• Advanced level of computer proficiency with Microsoft Office Suite including, Word, Excel and PowerPoint.
• Excellent oral and written communication skills.
• Self-starter who conducts daily activities with minimal or no direction
• Demonstrate a continuing education commitment with enrollment or completion in a leadership or technical structured training course Preferred, But Not Required
• Supervisory, director or Claims Manager experience.
• Multi-state experience a plus. Certification
• AIC, ARM, or CPC

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