Senior Risk Management Specialist

22 hours ago

Bethesda, Maryland, United States HMSHost Full time
Senior Risk Management Analyst

Job Summary:

The Senior Risk Management Analyst plays a critical role in ensuring the company's Workers' Compensation claims are managed effectively and efficiently. This position requires a strong understanding of risk management principles, technical claims procedures, and medical protocols.

Key Responsibilities:

  • Provide oversight to the company's Workers' Compensation claims in the US and Canada, ensuring timely and appropriate resolution.
  • Act as a liaison between Third-Party Administrators (TPAs) and Field Operations, guiding field management on accurate claim reporting, claim management, and return-to-work procedures.
  • Monitor TPA expenses, including assignment of outside claim investigators, nurse case management, physician reviews, and Medicare/SCHIP Set-Asides.
  • Coordinate complex claim resolution with Legal, including claims with ADA, EEOC, or FMLA components.
  • Conduct quarterly claim reviews, audits, and other claim-related projects to ensure compliance and identify areas for improvement.
  • Manage State Funded Workers' Compensation oversight, including uploads to the claim system, quarterly premium payments, and outside attorney assignment and expenses.
  • Identify claim trends and recommend training programs, procedures, and actions to reduce claim costs.
  • Develop and maintain state-required in-network physician panels.
  • Monitor the 24/7 Nurse Triage program and encourage location participation.
  • Stay up-to-date on claim practices, case law, and industry claim trends.
  • Process premium payments in the US and Canada.
  • Handle OSHA complaints, investigations, and formal responses.
  • Manage and oversee safety audits for compliance.
  • Manage and oversee the Company Slip Resistant program.

Requirements:

  • 3-5 years of technical claims experience with a carrier or TPA.
  • Bachelor's degree in a related field can count for 1 year 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 in federal and state-specific Workers' Compensation regulations and technical claims procedures.

What We Offer:

HMSHost is committed to providing a positive work environment and opportunities for growth and development.

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