Analyst, Risk Management – Workers’ Compensation
About The Position
This position is directly responsible for the supervision of our workers’ compensation claims program with a financial exposure for CVS. This involves the oversight of all workers’ compensation claims in an assigned territory that are handled by insurance carriers and Third-Party Administrators (TPA). This position is directly responsible for ensuring adherence to claim handling guidelines, analyzing TPA performance and directing claims handling. In addition, this position requires the ability to field and provide solutions on a high volume of inquiries from the CVS business units and departments.
Requirements
- 1-3 years’ experience handling Lost Time workers’ compensation claims and/or equivalent experience with TPA oversight.
- Experience in Microsoft Office applications with a proven ability to learn new software programs and systems as required.
Nice To Haves
- Insurance designations is a plus.
- California workers’ compensation claims handling experience or jurisdictional knowledge a plus.
- Ability to interact and navigate situations with both internal and external partners.
- Ability to work independently and in an environment requiring teamwork and collaboration.
- Ability to train less experienced TPA adjusters on implementation of claim best practices.
- Demonstrate excellent analytical, organizational, written, and communication skills, with the ability to generate concise claim outlines that capture and detail critical case components.
- Exhibit proven time management skills and the ability to oversee a high volume of cases effectively.
Responsibilities
- Proactively oversee and manage TPA performance through reporting, auditing, and claim reviews.
- Oversee the daily work product of multiple lost time and medical-only workers’ compensation adjusters in your assigned territory, completing monthly audits and case reviews.
- Actively participate in internal claim reviews and legal roundtables.
- Ensure that reserves and settlement authorities are reviewed and granted in compliance with our internal processes.
- Review and interpret medical reports, expert reports, legal and various supporting claim documents.
- Analyze case and internal investigative materials to determine legal liability and that reserves are set for the known exposure.
Benefits
- medical
- dental
- vision coverage
- paid time off
- retirement savings options
- wellness programs
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
High school or GED
