Claims Administrator

Weis Markets•Sunbury, PA

22h•Onsite

About The Position

The Claims Administrator provides support to the Risk Management Department in processing workers compensation, general liability, and pharmacy claims. The role works closely with our third-party administrators, and defense counsel to effectively manage the cost and closure of claims. The role performs all tasks according to company policies and state and federal laws. The role serves as a liaison between an injured associate, our Third-Party Administrator (TPA), and Weis Markets. Under general supervision, the role provides administrative and technical support to insurance carriers and third-party administrators. The role processes data, generates routine reports, and provides direct support to claim representatives. Other duties of the role include but are not limited to, answering telephones, filing, mail processing, document scanning, letter, and other document preparation.

Requirements

High school diploma or equivalent is required
Knowledge of Workers Compensation Laws and Occupational Safety and Health Administration Standards (OSHA)
Knowledge and understanding of Workers’ Compensation and General Liability claim handling
Knowledge of applicable statutes and regulations
Keep updated on any changed in the workers’ compensation information by periodically attending seminars/workshops.

Nice To Haves

associate or bachelor’s degree is preferred

Responsibilities

Reviews all new claims (intake)
Contacts stores and/or claimants to review status of injured associate, assist claimant with any questions that may have regarding their claim, and follow-up with claimant throughout the claim for updated medical information/return to work status.
Submits claim information into the appropriate TPA system.
Be available to assist TPA, Store Management, or Risk Management with questions regarding the claim.
Works with and obtains information from stores, claimants, vendors, field personnel and other internal or external resources.
Investigates losses to determine cause, scope, and extent of damages and/or liability and possible subrogation.
Reviews medical notes for work status and forward to appropriate TPA.
Works with store managers to coordinate a return to work for injured associates.
Answers correspondence and inquiries promptly from brokers/agents, TPA’s, claimants, doctors, attorneys, and outside vendors.
Obtain, verify, and retain Insurance Certificate of Insurance (COI)
Responsible for complying with proper internal controls as necessary to conduct job functions and/or carry out responsibilities and/or administrative activities.
Acts as a liaison between Weis Markets, its insurance provider and agents, and claimants
Recognizes when to refer complicated claim situations to various areas, outside firms and TPA’s.
Assists Supervisor, Claims Administration with OSHA 300 and 300A data and reports.
Responsible for maintaining allocations spreadsheet.
Updates electronic files with any additional information.
Responsible for reviewing and securing video of Workers Comp and General Liability Incidents.
May work on special projects as assigned.