WC Claims Specialist

7 days ago

Grand Rapids, MI, United States UFP Industries, Inc Full time

The WC Claims Specialist is responsible for claims management and issues related to work comp. This position works under general supervision; exercises discretion and relies on experience and judgment to plan and accomplish goals; and requires a certain degree of creativity and autonomy to perform the job.

Principal Duties and Responsibilities

  • Serves as primary contact for the field operations on WC related claim procedures and claims management issues

  • May serve as a back-up for FMLA, ADA, and disability related claim procedures and claims management issues

  • Assists with updating documentation and communication associated with related leaves of absences

  • Trains new plant HR/safety personnel, including acquisitions, on related leave of absence procedures

  • Produces quarterly trend reports and other related reports as requested

  • Assists with monitoring federal and state leave regulations and with working with vendors and plants to implement any necessary updates to existing procedures

  • Monitors claim activity to ensure timely and accurate delivery of benefits

  • Provides assistance to the field regarding medical management and return to work

  • Reviews claim data to ensure that claims are managed, paid, and resolved according to service criteria

  • Ensures that all claims are reviewed for appropriateness of acceptance or denial

  • Advises the field in identifying and maintaining quality medical providers

  • Assists in the identification of legal counsel with assistance from the claim managers/TPA

  • Assists in developing legal strategy for each litigated case

  • Advises the field in transitional and long-term return-to-work strategies

  • Ensures that the claim managers/TPA pay medical bills and other related invoices promptly

  • Provides guidance and related training to plant personnel with work comp responsibilities

  • Helps maintain documentation, legal evidence, and other related file administration

  • Maintains updated knowledge of state comp laws or other legal changes impacting areas of responsibility

  • Advises the field and claim managers/TPA in investigating aspects of serious or questionable claims

  • Acts as a liaison between injured worker and TPA/carrier

  • Prepares and participates in strategic claim resolution meetings

  • Assists with providing information to TPA/legal counsel in response to subpoena requests

  • May assist with training for other related areas of responsibility

  • May assist with policy updates for related areas of responsibility

  • May serve as backup for Substance Abuse policy administration

  • May serve as backup for other various safety related program administration

  • Performs other duties as required.

Job Specifications

Knowledge

  • Bachelor's degree or equivalent experience in a related field

  • Formal, working knowledge of claims management protocol and related employment law

  • Some knowledge and understanding of medical terminology

Skills and abilities

  • Ability to solve problems and apply knowledge and education in complex situations

  • Ability to maintain and safeguard confidential information

  • Verbal and written skills with the ability to communicate at all levels within the organization

  • Interpersonal and problem-solving skills

  • Demonstrated ability to use computers and related business software and experience with advanced excel or other report writing programs

  • Ability to understand, analyze, and communicate financial information as a management tool

  • Ability to coordinate and prioritize case load

  • Ability to travel as required

Conduct

  • Team player and goal oriented

  • Leads by example

The Company is an Equal Opportunity Employer.

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