Workers Compensation Claim Specialist

Choctaw Nation of Oklahoma•Durant, OK

About The Position

The Workers’ Compensation Claim Specialist will provide careful diagnosis, treatment, and expedition of workers’ compensation claims while applying Occupational Safety & Health recordkeeping practices.

Requirements

Bachelor’s degree in general studies/a Licensed Registered Nurse (RN)/a Licenses Practical Nurse (LPN)/ or 10 years of practical experience in lieu of education
Workers’ Compensation Adjuster License or ability to attain License within 90 days of hire.
Ability to determine compensability and the need for subrogation.
Knowledge of Workers’ Compensation Systems
Knowledge of statutes to analyze situations.
5 years’ experience adjusting claims and reserving claims.
Knowledge of Medical Terminology
Knowledge of Occupational Safety & Health injury and illness reporting

Responsibilities

Assess and review complex claims ensuring compensability, proper identification of causation of the injury/illness, and directing medical care plans for the associate.
Review medical diagnosis, monitor all follow-up appointments ensuring medical providers and associates are proactive in their recovery and treatment.
Schedule surgeries and other medical treatment with authorized medical providers.
Knowledgeable of Safety Policies, strengthening our understanding of the incident, and identifying willful or negligent conduct.
Be able to triage compensable claims into applicable OSHA reporting tools such as the OSHA 300 record keeping log.
Assign appropriate reserves and determine reimbursement money to medical providers, team members, and fee schedule for payments made to medical providers.
Calculate injury leave, mileage, and submit to the accounting team for benefit payments.
Liaison between CNOSH and Workers’ Compensation on OSHA reporting
Assist with internal case management responsibilities between CNHSA, CNOSH, and outside medical providers.
Perform all other tasks as assigned.