Claims Management Specialist

1 week ago

Madison, Wisconsin, United States Universities of Wisconsin Full time

About the Organization

The Universities of Wisconsin represent a distinguished system of public higher education, serving approximately 162,000 students annually and employing around 35,000 faculty and staff throughout the state.

With a network of 13 universities, the Universities of Wisconsin stand as a vital academic, cultural, and economic asset for the state, the nation, and the global community.

Mission of the Office of Risk Management

The Office of Risk Management is dedicated to fostering a safe and healthy educational environment for students, faculty, staff, and visitors engaged in UW System programs and facilities. Our commitment is realized through:

  • Proactive loss prevention and health, safety, and environmental management.
  • Effective management of property, liability, and workers' compensation claims.
  • Protection of the assets of the UW System.
  • Conducting risk assessments and developing mitigation strategies.

The Office is responsible for establishing and maintaining emergency management systems, monitoring high-risk areas, providing expert guidance on workers' compensation claims and workplace injuries, and negotiating insurance policies on behalf of the UW System.

Position Overview

This role involves managing a designated segment of university employee workers' compensation claims under the close supervision of the lead Senior Examiner and the Risk Manager.

Key Responsibilities

The primary duties of this position include:

  • Receiving and investigating claims to determine approval, suspension, or denial in accordance with statutory guidelines.
  • Issuing timely workers' compensation benefits following compensability determinations and maintaining appropriate case reserves.
  • Interpreting and assessing medical reports to ascertain benefits eligibility.
  • Handling confidential employee data and medical records with discretion.
  • Recommending the use of third-party services, including private investigations and independent medical examinations.
  • Evaluating potential third-party lawsuits and informing relevant parties of the state's subrogation interests.
  • Assisting campuses in developing early return-to-work programs to help injured workers regain their pre-injury health and employment status.
  • Processing medical bill payments when appropriate and authorizing payments for bill reviews.

Minimum Qualifications

While prior experience in workers' compensation is advantageous, entry-level candidates are encouraged to apply as on-the-job training will be provided. Candidates must possess:

  • Strong written and verbal communication skills.
  • Proficiency in Microsoft Office applications.
  • Exceptional customer service abilities.
  • The capacity to analyze complex problems and make independent decisions.

Preferred Qualifications

Ideal candidates will have significant experience in:

  • Claims management.
  • A foundational understanding of medical terminology.
  • Knowledge of relevant workers' compensation laws and return-to-work programs.

Commitment to Inclusive Excellence

The Universities of Wisconsin embrace Inclusive Excellence as a source of strength and innovation. We value the contributions of individuals from diverse backgrounds and are committed to fostering an inclusive community that enriches the educational experience.

Conditions of Employment

All candidates must undergo a criminal background and sexual harassment check prior to employment. Successful applicants are responsible for ensuring their eligibility to work in the United States.

Work Location

Telecommuting or hybrid work options may be available following a satisfactory probationary period.

Compensation and Benefits

This is a full-time, salaried position with a competitive salary range based on qualifications and experience. Employees enjoy a comprehensive benefits package.

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