Workers Compensation Specialist Resume
Summary : 13+ years of experience as a Workers Compensation Specialist. Highly motivated, skilled and accomplished professional with diverse Safety and Workers compensation experience in non-union and union business environments. Strong customer service orientation, with the ability to work in a fast paced environment.
Skills : Microsoft Office, Customer Service, Office Management, Excel, Word Processing, And Medical Terminology.
Description :
- Currently responsible for high level and daily strategic monitoring of claims handling by the programs company's claims administrators. the activities of corporate groups and all facilities throughout the US.
- Partnering with the executive group and implemented new workers compensation processes at facilities in the US.
- Responsibilities included managing claims with the focus on medical management, return-to-work program, modified duty evaluations, and to ensure adherence to the processes.
- Heavy interaction with plant safety managers and hr managers at each facility as it relates to any event or alleged incident. Make the determination as to whether a claim will be accepted or postured for denial.
- Interfacing with adjusters, medical professionals, as well as workers compensation attorneys in specific states.
- In concert with state-specific legal counsel and adjuster, made final settlement recommendations to management.
- Extensive knowledge of multi-state specific workers compensation laws.
- Meeting monthly with corporate finance, analyze and provide forecasting for workers compensation to the executive team.
- Restructured processes on accident reporting and handling of injury with safety managers and hr department in the Americas to create a shared service team and strengthen resources for future.
- Reviewing current and future business needs and created a strategic business plan for the function. The focus was to eliminate liabilities resulting in claims reduction.
- Training managers on ways to improve, follow and evaluate processes, monitored and assisted in the multi-state training of their subordinates to create a strong team which has yielded positive results.
- Creating job function analysis templates related to not only workers compensation, but for job accommodation requests, and partnered with corporate HR director to train all HR managers on the Americans with disability act and how to utilize templates.
Experience
10+ Years
Level
Senior
Education
BA
Workers Compensation Specialist Resume
Summary : 7+ years of experience as a Workers Compensation Specialist is seeking to obtain a position utilizing my skills in sales, marketing, underwriting, supervising, writing, and customer service.
Skills : Microsoft Word, Database, Spreadsheet, PowerPoint, Invision, DAR, AS400, Revell, & Powerchart.
Description :
- Working with employers, insurance agents and carriers to help with employer safety programs for.
- Assessing employer programs and making recommendations with regards to their safety elements.
- On-site visits and audits to verify employer safety parameters are met including the review of the lock.
- Reviewing loss runs, preparing risk summary reports, gathering and examining claims information (frequent types of claims, frequent claimant names, litigation, types of serious incidents).
- Reviewing accident investigations making sure root cause analysis and claim mitigation.
- Procedures are in place including modified duty offerings, and, then, putting all data and.
- Comments on a worksheet for the governors cost containment board to review.
Experience
7-10 Years
Level
Executive
Education
BA
Workers Compensation Specialist Resume
Objective : 2+ years of experience as a Workers Compensation Specialist. Demonstrated success in all areas of team and office management, reviewing files and researching discrepancies and analyzing and resolving complex problems. Recognized by management as results-oriented and selected by leadership to participate in specialized projects.
Skills : Microsoft, Supervision, Office Management, Clerical, Case Management, Workers Compensation, Insurance Verification, Patient Collections, Billing, And Administrative Assistant.
Description :
- Responsible for assisting the administration of the workers' compensation program including injury intake, processing claims, determining the appropriateness of claims and maintaining and updating case records.
- Determination of compensability of injuries and payment of total temporary disability, permanent disability, and medical, legal, investigative and other costs associated with workers compensation claims.
- Overseeing return to work program and handling of disability cases to determine the availability of modified work.
- Assisting field offices with resolving questions and issues pertaining to incidents and claims of injury.
- Providing immediate assistance to all field and TPA staff in response to injury notification.
- Assisting with requesting manual codes from BWC, NCCI database, and insurance carrier for multiple entities and maintain records of codes.
- Receiving and triaging injury reporting calls from the injury intake line throughout the day and after hours on a rotating basis.
- Processing invoices received in the workers' compensation department including determining approval status, reducing to fee schedule where appropriate, correlating payment information, and auditing for duplicate submissions.
- Auditing customer files for appropriate job classifications, approval, and coding.
- Monitoring and reviewing changes in legislation both at the federal and state level and make changes as needed to ensure the compliance of the company.
- All other duties that may arise to ensure the successful operation of the company.
Experience
2-5 Years
Level
Junior
Education
Associate
Workers Compensation Specialist(temp) Resume
Objective : 3 years of experience as a Workers Compensation Analyst. Ambitious to embark on a strategic level position in a dynamic environment, where I can utilize my professional and leadership skills to contribute towards the organization's growth.
Skills : Financial Accounting, Business Ethics, Principles Of Management, Economics, Managerial Statistics, Organizational Leadership, Insurance Verification, Patient Collections, Billing, And Administrative Assistant.
Description :
- Interact and communicate regularly with all levels of the company, assuring that accident and injury investigations are thorough and accurate so that timely liability/compensability and claim resolution decisions can be made.
- Document and diary assigned WC claim files to keep branch managers informed of developments on assigned claims.
- Monitor reserve activity on assigned claims and give feedback to the carrier as needed.
- Monitor the quality of work performed by the carrier adjusters, attorneys, and vendors.
- Determine claim values, communicate settlement authority, and maintain settlement log.
- Use of Dunbar's safety-related databases and the carrier databases to conduct analysis, identify trends, develop and implement solutions to positively impact results.
- Assist defense counsel and the claim carrier with the handling of litigated claims to include the preparation of draft answers to discovery requests.
- Attend depositions, mediations, arbitrations, pre-trials, trials and all other legal proceedings, as needed.
Experience
2-5 Years
Level
Junior
Education
MBA
Workers Compensation Specialist Resume
Headline : 5+ years of experience as a Workers Compensation Specialist is seeking to obtain an Administrative position where I can apply my knowledge and experience to the success of my employer.
Skills : Workers Compensation, Insurance Verification, Patient Collections, Billing, Administrative Assistant, Claims, EDI, And Electronic Data Interchange.
Description :
- Thoroughly investigate and analyze the facts surrounding a work-related event.
- Determine independently whether the claim for benefits should be accepted or denied.
- Issue appropriate bureau of workers compensation documents within 14-21 days of disability.
- Manage claims involving medical conditions that lead to complicated long-term medical-only claims, claims involving restricted duty limitations, and disability from work as a result of significant medical or surgery.
- Manage claims in litigation for review, suspension, termination, and settlement of benefits.
- Evaluate and determine independently monetary reserves to be assigned to cover the potential exposure of a claim.
- Maintain excellent and open relationships with clients while always displaying a high level of customer service.
Experience
5-7 Years
Level
Executive
Education
BS
Workers Compensation Specialist Resume
Objective : One year of experience as a Workers Compensation Specialist is looking to obtain a position in the Administrative development and support applying my extensive experience in Marketing/Sales and Strategic Development with a focus on Benefits, Workers Compensation, Integrated disability and Safety and Risk Analysis.
Skills : Workers Compensation, Risk Analysis, Microsoft Office Outlook, Microsoft Office Excel, Microsoft Office Word, Claims, EDI, And Electronic Data Interchange.
Description :
- Contract position as a workers compensation specialist with the home office of express.
- Assist employees with his/her work-related injury from the 1st report of injury to injury investigation.
- Review and process bills working with the 3rd party administrator who administers the WC.
- Providing explanations of the WC process to associates in multiple jurisdictions (multi-state).
- Review and process bills working with the 3rd party administrator who administers the WC.
- Provides oversight on clients behalf regarding claim handling procedure complete.
- Review and process WC subpoenas as well as the day to day claim handling and processing of workers compensation leave of absence forms.
Experience
0-2 Years
Level
Entry Level
Education
Diploma
Workers Compensation Specialist Resume
Objective : 3+ years of experience as a Workers Compensation Specialist is seeking to secure a position within a company where I can prove my hardworking ability and contribute to the growth of the company.
Skills : Microsoft Office Outlook, Microsoft Office Excel, Microsoft Office Word, Claims, EDI, Electronic Data Interchange, Excel, And ISO.
Description :
- Analyzing and managing complex or technically difficult claims by investigating and gathering information to determine the exposure on the claim; manage claims through well-developed action plans to an appropriate and timely resolution.
- Reviewing workers compensation accounts against state-mandated schedules and guidelines; identify managed care contracts; review claims against applicable contracts, and submit any discrepancies for payment and appeals.
- Assessing liability and resolve claims within the evaluation. Negotiate settlement of claims within designated authority.
- Calculating and assign timely and appropriate reserves to claims; manage reserve adequacy throughout the life of the claim.
- Calculating and pay benefits due; approve and make timely claim payments and adjustment, and settle claims within designated authority level.
- Managing the litigation process; ensuring timely and cost-effective claims resolution.
- Using appropriate cost containment techniques including strategic vendor partnerships to reduce the overall cost of claims for our clients.
- Communicating claim activity and processing with the claimant and the client; maintain professional client relationships.
Experience
2-5 Years
Level
Junior
Education
HS
Workers Compensation Specialist Resume
Headline : 5+ years of experience as a Workers Compensation Specialist. I am very responsible and proficient in everything that I do. Goal -oriented and dedicated to high levels of customer satisfaction and meeting aggressive business goals.
Skills : Customer And Personal Service, Judgment And Decision Making, Active Learning, Time Management, Active Listening, And Complex Problem Solving.
Description :
- Investigating and processing company-wide workers’ compensation claims.
- Reviewing loss report forms and related forms to determine if they contain sufficient information to make a valid claim.
- Gathering additional information by requesting statements from witnesses, supervisors, claimants, doctors and other medical providers.
- Determining when investigations and independent medical examinations are required.
- Evaluating facts and applies a law in order to recommend approval/denial of claims.
- Maintaining files for claims in order to document data, reserves, and payments.
- Answering questions from claimants and other parties; explains legal requirements and procedures which apply to workers’ compensation claims.
- Electronically submits all necessary reports to proper insurance carrier/ TPA.
Experience
5-7 Years
Level
Executive
Education
Psychology
Workers Compensation Specialist Resume
Headline : 5+ years of experience as a Workers Compensation Analyst is seeking a career position in the Human Resources function, in order to use my education and experience while further growing my career.
Skills : Claims, EDI, Electronic Data Interchange, Excel, ISO, Microsoft Word, Microsoft Word, MS Office, Microsoft Outlook, Research, Research, Writing, Communication, Communication, Conflict Resolution, And Customer Service.
Description :
- Responsible for administration of high volume workers compensation claims through an owner-controlled insurance program. An average weekly caseload of 110 open claims across five different states (California, Kansas, Oregon, Texas, and Arizona) with varying degrees of severity.
- Coordinating with a subcontractor, safety, and other related departments as necessary for accident investigation and claim administration.
- Communicating with the occupational health center, nurse case manager, defense counsel, and insurance company regarding diagnosis, course of treatment, and claim resolution.
- Managing aggressive return to work program to minimize days away restricted or transferred rates.
- Coordinating with safety and employees manager to determine an appropriate work assignment within the scope of the employee's restrictions.
- Recommending action/s to verify the validity of a claim of occupational injury.
- Partner with environmental health safety department to proactively identify and correct potentially unsafe situations.
Experience
5-7 Years
Level
Executive
Education
BS
Workers Compensation Specialist Resume
Headline : 5 years of experience as a Workers Compensation Specialist. Strong interpersonal communication skills. Able to complete tasks quickly and proficient.Growing customer relationships.
Skills : Microsoft Word, MS Office, Microsoft Outlook, Microsoft Outlook, Research, Research, Writing, Communication, Conflict Resolution, And Customer Service.
Description :
- Oversees the timeliness and accuracy of all aspects of a workers compensation claim.
- Advice educates and collaborates with departmental workers compensation managers.
- Audits and monitors in-process visits and follow-up visits for adherence to policies and procedures.
- Develops and manages relationships with appointed departmental workers compensation liaisons.
- Oversees the maintenance of systems to gather, track, and report information to support the workers' compensation program.
- Develops and analyzes program metrics; creates and distributes reports on the progress of each initiative.
- To analyze complex or technically difficult workers compensation claims to determine benefits due; to work with high exposure claims involving litigation and rehabilitation; to ensure ongoing adjudication of claims within service expectations, industry best practices, and specific client service requirements; and to identify subrogation of claims and negotiate settlements.
Experience
5-7 Years
Level
Executive
Education
BS
