Workers' Compensation Adjuster

2 weeks ago

New Haven, United States Yale New Haven Health Full time

Overview: To be part of our organization, every employee should understand and share in the YNHHS Vision, support our Mission, and live our Values. These values - integrity, patient-centered, respect, accountability, and compassion - must guide what we do, as individuals and professionals, every day.

Has responsibility for performing a variety of duties requiring the regular use of independent judgement to manage and administer assigned Workers' Compensation Claims. Remains current on Workers' Compensation trends and impending or new legislation affecting the program. Provides assistance to staff members in support of other benefit programs.

EEO/AA/Disability/Veteran Responsibilities:
1. Performs review of new Workers' Compensation claims in order to ensure compensability, proper documentation of injury, completeness of information and determine current medical status.
- 2. Regularly involved in negotiations with claimants, physicians, attorneys and the Commissioner to determine appropriate course of action necessary for efficient claims management or settlement.
- 3. Works directly with medical providers to gather medical information on a necessary basis to ensure the file is complete. Authorizes medical treatment or procedures and based on practiced protocols or within the YNHHS Medical Care Plan.
- 4. Determines most effective method and timing of ongoing follow up to bring cases to closure in order to limit the hospital's exposure. Recommends stipulation amounts and opportunities based on knowledge of the claim development.
- 5. Regularly reviews files to identify potential recoveries from third parties. Takes appropriate action to initiate potential recoveries.
- 6. Monitors progress of all claims activity to ensure proper valuing and case management.
- 7. Calculates and verifies all Workers' Compensation indemnity payments and authorizes medical payments.
- 8. Establish financial reserves with documented rational. Review and adjust the reserves for the life of the claim and to reflect any changes in exposure. Notify and update excess carriers if claim is near or over retention.
- 9. Represents the YNHHS at hearings before the State of Connecticut Compensation Commissioner throughout the State of CT.
- 10. Determines and develops claim information to be presented at WCC hearings.
- 11. Regularly meets with Occupational Health and Wellness Services, departments, and Employee Relations to review employee restrictions and to develop modified duty/return-to-work programs.
- 12. Advises departments on the proper payroll procedure once a claim has been filed to ensure an employee is being paid properly.
- 13. Develops and forwards informational packets to employee, manager and/or physician once a claims file is initiated.
- 14. Develops and maintains appropriate information necessary to document settlement activities, loss control practices, track reserves, develop sound management reports, and meet statutory requirements.
- 15. Remains current on Workers' Compensation trends and impending or new legislation affecting the program.
- 16. Generally supports the efforts of the Compensation and Benefits Department to provide services, information and communication to the general employee population and the Hospital Management Staff.
- 17. Must be able to travel for business purposes and/or attend hearings throughout the State of CT.

Qualifications:
EDUCATION

Bachelor's degree or equivalent work experience.

EXPERIENCE

Three (3) to five (5) years of experience in handling Workers' Compensation claims requiring a strong working knowledge of Connecticut Workers' Compensation laws.

LICENSURE

Current Connecticut Licensed Claims Adjustor required.

SPECIAL SKILLS

Must be able to work independently with mínimal supervision.. Strong Microsoft Office skills especially, Excel. Excellent typing and data entry skills. Ability to make arithmetic calculations and work frequently with figures. Good oral and written communication and interpersonal skills.

PHYSICAL DEMAND

Travel is required 2-3 days per week to/from New London/Norwich/Hartford and other locations outside of greater New Haven.

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