Claims Manager - Workers' Compensation

State of Colorado • Denver, CO

4d • Hybrid

About The Position

The Department of Labor and Employment connects workers with great jobs and assists those who have been injured on the job. We help people who are unemployed through no fault of their own by providing temporary wage replacement and we ensure fair labor practices. We provide an up-to-date and accurate picture of the economy that helps in decision making. And we protect the workplace – and Colorado communities – with a variety of consumer protection and safety programs. This is a values-driven organization, committed to accountability, agility, collaboration, and respect. We believe in outstanding customer service, an inclusive culture, continued process improvement and in our role as a trusted and strategic partner. Recognizing that knowledgeable employees drive our success, we are seeking dedicated individuals who exhibit our shared values and our passion for quality and excellence in all we do. This position is responsible for the hands-on administration of the Workers’ Compensation Act and Rules of Procedure with regard to claims handling. This position provides daily reviews, monetary audits, education, training and information for all parties to claims, plus intervenes in workers’ compensation related matters, as well as other related claims duties assigned. The Claims Managers assist claimants, attorneys, medical providers, and employers in processing their workers’ compensation claims by interpreting and explaining case law, regulations (statutes), and rule procedures, as well as intervening between parties to resolve claim issues before escalating to the hearing process. The position monitors insurance carriers and TPAs to ensure compliance with applicable statutes and rules, and assesses penalties for non-compliance when necessary, as well as educate and train claims representatives on new and old case law, statutes and revised statutes, existing rules and revised rules. This position reviews claim filings from 1983 to present, which includes three (3) statute changes, and multiple rule changes.

Requirements

• Must be a current resident of Colorado.
• Must pass a thorough background check prior to employment which will include the E-Verify process.
• Five (5) years of relevant experience in an occupation related to the work assigned to this position to include: Claims adjusting related work and duties, workers compensation claims management to include form completion and submission, calculating benefit wages, familiarity with the type of benefits, rules and regulations claimant communications.
• A combination of related education and/or relevant experience in an occupation related to the work assigned equal to five (5) years.

Nice To Haves

• Experience performing similar duties as a State of Colorado classified employee.
• 1-2 years of experience in claims adjusting: paying out lost wage benefits, authorizing medical treatment, investigating claims for compensability, etc.

Responsibilities

• Hands-on administration of the Workers’ Compensation Act and Rules of Procedure with regard to claims handling.
• Provides daily reviews, monetary audits, education, training and information for all parties to claims.
• Intervenes in workers’ compensation related matters, as well as other related claims duties assigned.
• Assists claimants, attorneys, medical providers, and employers in processing their workers’ compensation claims by interpreting and explaining case law, regulations (statutes), and rule procedures.
• Intervenes between parties to resolve claim issues before escalating to the hearing process.
• Monitors insurance carriers and TPAs to ensure compliance with applicable statutes and rules.
• Assesses penalties for non-compliance when necessary.
• Educates and trains claims representatives on new and old case law, statutes and revised statutes, existing rules and revised rules.
• Reviews claim filings from 1983 to present, which includes three (3) statute changes, and multiple rule changes.

Benefits

• Strong, secure, yet flexible retirement benefits including a PERA Defined Benefit Plan or PERA Defined Contribution Plan plus 401(k) and 457 plans
• Medical and dental health plans
• Employer supplemented Health Savings Account
• Paid life insurance
• Short- and long-term disability coverage
• 11 paid holidays per year plus vacation and sick leave
• BenefitHub state employee discount program
• MotivateMe employee wellness program
• Excellent work-life programs, such as flexible schedules, training and more
• Access to participate in employer-supported employee affinity spaces
• RTD EcoPass Commuter Program
• Some positions may qualify for the Public Service Loan Forgiveness Program.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: No Education Listed