Claims analyst

Acrisure•Springfield, IL

11d•$45,000 - $55,000•Onsite

About The Position

The Claims Analyst, Senior Claims Analyst independently adjudicates multi-state workers’ compensation indemnity, EL and subrogation claim files that are generally non-catastrophic in nature. ESSENTIAL FUNCTIONS Receives lost time assignments. Verifies and determines applicability of coverage. Completes 24 hour contact with employer, employee and attending physician inclusive of telephonic contact, recorded statements and/or in person interviews with insured, employee, physician, and witnesses. Reviews all coverage issues and determines compensability within Midwest standards. Aggressively manages all aspects of the workers’ compensation claims management process inclusive of litigation, and providing direction to defense counsel. Responsible for customer relations management, consistently establishing and maintaining high levels of trust and confidence with clients, through constant contacts, prompt response and resolving client’s questions and claim issues. Responsible for setting of reserves to Ultimate Probable Cost (UPC).Sets reserves for anticipated exposure subject to authority limits. Addresses timely benefit delivery including production of benefit notices to the injured party as required in the applicable jurisdiction. Coordinates return to work (RTW) in accordance with the medical disability plan for the injured worker. Negotiates settlements directly with the injured worker or opposing counsel. Considers Medicare’s interests related to Conditional payments and injured workers eligibility and settlements. Recognizes and manages 3rd party liability and subrogation through recovery. Reviews medical and expense bills for causal relationship and bill charges over $1500.00. Consults with Claim Supervisor/Claims Manager/Executive claims on files where assistance and consultation are needed. Completion of Claim Status reports. Makes assignments to nurse case management when indicated, monitoring their billing and performance. Coordinate claim review meetings with both internal and external parties. Attend hearings and depositions when required. All other duties as assigned.

Responsibilities

Receives lost time assignments.
Verifies and determines applicability of coverage.
Completes 24 hour contact with employer, employee and attending physician inclusive of telephonic contact, recorded statements and/or in person interviews with insured, employee, physician, and witnesses.
Reviews all coverage issues and determines compensability within Midwest standards.
Aggressively manages all aspects of the workers’ compensation claims management process inclusive of litigation, and providing direction to defense counsel.
Responsible for customer relations management, consistently establishing and maintaining high levels of trust and confidence with clients, through constant contacts, prompt response and resolving client’s questions and claim issues.
Responsible for setting of reserves to Ultimate Probable Cost (UPC).
Sets reserves for anticipated exposure subject to authority limits.
Addresses timely benefit delivery including production of benefit notices to the injured party as required in the applicable jurisdiction.
Coordinates return to work (RTW) in accordance with the medical disability plan for the injured worker.
Negotiates settlements directly with the injured worker or opposing counsel.
Considers Medicare’s interests related to Conditional payments and injured workers eligibility and settlements.
Recognizes and manages 3rd party liability and subrogation through recovery.
Reviews medical and expense bills for causal relationship and bill charges over $1500.00.
Consults with Claim Supervisor/Claims Manager/Executive claims on files where assistance and consultation are needed.
Completion of Claim Status reports.
Makes assignments to nurse case management when indicated, monitoring their billing and performance.
Coordinate claim review meetings with both internal and external parties.
Attend hearings and depositions when required.
All other duties as assigned.