Analyst, Workers' Compensation (Legal)

DaVita • El Segundo, CA

11h • Onsite

About The Position

The Workers' Comp Specialist is responsible for handling and oversight of DaVita’s Workers’ Compensation claims and acts as a direct liaison between DaVita’s management staff, teammates, claim adjusters, and defense counsel. Position directs claims resolution activities including claim reserve analysis and claim settlements.

Requirements

• Bachelor’s degree in related area highly preferred
• Workers’ Compensation certification preferred; certification or experience in multiple jurisdictions preferred including but not limited to state mandated certificates such as WCCP, WCCA, etc.
• Minimum of three years’ experience managing and/or handling Workers’ Compensation claims required
• Intermediate computer skills and proficiency in MS Excel, Word, PowerPoint, and Outlook required
• High school diploma or equivalent required
• Minimum of three (3) years' healthcare reimbursement experience preferred
• Demonstrated knowledge of insurance rules, regulations and Coordination of Benefits for federal, state, and managed care payors in multiple states preferred
• Basic computer skills and proficiency in MS Word, Excel, and Outlook required

Nice To Haves

• experience with admissions, billing, and collections preferred

Responsibilities

• Evaluate claims to determine potential exposure; make recommendations concerning the value of the claim; oversee litigation and assist in the negotiation of settlements
• Escalate issues as appropriate for prompt and effective resolution
• Proactively oversee the Worker’s Compensation claims management activities in assigned territories and resolve problems of varying scope and complexity in accordance with state statutes
• Evaluate high exposure Workers’ Compensation claims for settlement and appropriateness of established reserves
• Attend claims audits and reviews; ensure claims are postured for expedited resolution
• Provide daily assistance to DaVita’s management staff, teammates, claims adjusters, insurers, and defense counsel by answering claims-related questions or concerns in the administration and management of claims, and other claims matters
• Facilitate and coordinate teammate return-to-work by working with DaVita management, claims adjusters, and nurse case managers.
• Analyze claims data to identify needed loss control interventions and assist with the development of appropriate loss prevention programs as requested
• Provide training and education to facilities on Workers’ Compensation processes and procedures as needed or requested
• Coordinate the handling of Workers’ Compensation subpoenas in an expeditious manner
• Provide reporting and analysis on key metrics related to assigned territory(ies), including analytics on projected and/or established medical provider networks
• Escalate exceptions, outliers, or circumstances that are out-of-norm to Corporate Claims Manager as they occur and seek guidance in resolutions
• Participate in meetings, presentations, and special projects, as necessary
• Attend team meetings, phone conferences, and training sessions
• Know, understand, and follow teammate guidelines, employment policies, and department or company procedures

Benefits

• Medical, dental, vision, 401(k) match, paid time off, PTO cash out
• Family resources, EAP counseling sessions, Headspace®, backup child and elder care, maternity/paternity leave
• DaVita offers a variety of programs to help strong performers grow within their career and also offers on-demand virtual leadership and development courses through DaVita’s online training platform StarLearning.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level