Senior Risk Management Analyst

2 weeks ago

Bethesda, Maryland, United States HMSHost Full time
Job Summary

The Senior Risk Management Analyst is responsible for providing oversight to the company's Workers' Compensation claims in the US and Canada, ensuring timely and appropriate resolution through appropriate compensability determination, reserving, and settlement evaluation. This position acts as a liaison between Third-Party Administrators (TPAs) and Field Operations.

Key Responsibilities
  • Guides field management on ensuring accurate claim reporting, claim management, and return-to-work procedures.
  • Monitors TPA expenses regarding assignment of outside claim investigators, nurse case management, physician reviews, Medicare/SCHIP Set-Asides.
  • Coordinates complex claim resolution with Legal, including claims that have an ADA, EEOC, or FMLA component to the Worker's Compensation claim.
  • Provides oversight of third-party administrator by conducting quarterly claim reviews, audits, and other claim-related projects.
  • Provides and manages oversight of the Company National Occupational Medical vendor.
  • Manages State Funded Workers' Compensation oversight regarding uploads to claim system, quarterly premium payments, and outside attorney assignment and expenses.
  • Identifies claim trends and recommends training programs, procedures, and actions to reduce claim costs.
  • Develops and maintains state-required in-network physician panels.
  • Monitors 24/7 Nurse Triage program and encourages location participation.
  • Updates knowledge base on claim practices, case law, and industry claim trends.
  • Processes premium payment in US and Canada.
  • Handles OSHA complaints, investigations, and formal response.
  • Manages and oversees safety audit for compliance.
  • Manages and oversees the Company Slip Resistant program.
Requirements
  • Education and Experience: The combination of education and professional experience must exceed 3 years.
  • In a technical role: Requires 3-5 years of technical claims experience with a carrier or TPA.
  • A bachelor's degree in a program related to the functional area can count for 1 of the 3-year requirement.
  • Preferred experience working in Risk Management in the Food & Beverage, Retail, or Hospitality industry and across multiple locations.
  • Specialized Training: Training that leads to federal and state-specific Workers' Compensation regulations.
  • Training that leads to a strong understanding of technical claims procedures, medical protocols, and best practices.
Preferred Qualifications
  • Proficient in Microsoft Office and Claim Management Systems.
  • Requires the ability to use discretion and uphold a high level of confidentiality.
  • Business acumen and also has the mindset required to understand the long-term implications of risk management planning and to advance the organization's goals.
  • Demonstrated history of understanding the needs of the business, stakeholders, the employee population, and individual circumstances.
  • Demonstrated history of creating and maintaining positive work environments.
Location

This position is based at the F&B Center of Excellence in Bethesda, MD.

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