Workers' Compensation Claims Analyst - Hybrid

University of Illinois System•Urbana, IL

3d•Hybrid

About The Position

The primary function of this position is to minimize financial losses against the University of Illinois and its employees by the prompt identification, investigation, analysis, and recommendation for disposition of workers' compensation claims. The Workers' Compensation Claims Specialist interacts with University staff to implement appropriate loss control programs or procedures designed to mitigate the frequency and severity of such losses.

Requirements

Bachelor's degree.
A total of one (1) year (12 months) in education, training and/or work experience in workers' compensation claims administration, including claims investigation, analysis, case management, and/or resolution.
Very strong verbal and written communication skills.
Ability to recognize the delicate and sensitive nature of information.
An understanding of the importance of maintaining discretion and confidentiality of information at all times.
Ability to use independent judgment in determining the weaknesses and strengths upon which the University's defense may be based.
Solid experience preparing claim reports and summaries.
Ability to use critical thinking in order to make decisions as to the relative importance of various medical facts and circumstances surrounding workers' compensation claims.
Excellent keyboarding, grammar, and proofreading skills, with strong emphasis on accuracy and applicable formats and criteria, to prepare and process correspondence, reports, and other documents that appropriately reflect University and department standards.

Nice To Haves

A Master's Degree in an area consistent with the duties of the position may be substituted for one (1) year of work experience.
Two years demonstrated experience in one or more of the following areas: insurance, risk management, workers' compensation, group insurance, healthcare, or liability claims.
Basic legal knowledge in the area of Illinois Workers' Compensation, including an understanding of Medicare considerations related to workers' compensation claims.

Responsibilities

Investigate claims as instructed by the Sr Associate Director by conducting in-depth investigations into allegations against the University and/or its employees of any potentially compensable workers' compensation events, e.g., occupational injury and/or occupational disease claims.
Secure all potential evidentiary materials such as the accident report, medical records, X-ray films, photographs, and statements to justify accepting the compensability of the claim.
Input claim information as needed into the database, including use of a diary system and comprehensive notes regarding claim status.
Perform a detailed claims analysis. Analyze all documentation in order to approve appropriate medical treatment, establish initial case reserves and subsequent updates, and make referrals for nurse case management/vocational rehabilitation/utilization and peer review as needed.
Identify potential Medicare considerations and understand Medicare's interest in Workers' Compensation cases.
Authorize medical and temporary total disability payments on approved claims.
Prepare a written investigative report which includes interviews with all witnesses, co-workers, supervisors, medical practitioners, and others involved in the claim. Consultation with experts and medical and legal research may be required.
Consult with outside legal counsel in furtherance of the legal defense of the University, its staff and other employees. Review outside counsel legal bills for appropriateness and accuracy before authorizing funds expenditure.
Prepare a written summary of allegations and analysis of each claim, focusing on the weaknesses and strengths of the University's position. A crucial element of the summary is a recommendation for a positive defense strategy to be presented to the Workers' Compensation Review Committee for review and reserving of funds.
As needed, settle claims if investigation reveals the claim is compensable, and the injury/illness justifies payment of a permanent settlement.
Monitor and periodically review assigned cases with the Sr Associate Director in order to maintain continued evaluation and assessment of the progress of claims.
Design, develop, and deliver lectures and presentations to promote the concepts of claim prevention and management as well as transitional work provisions; make units aware of their loss history and how practices have contributed to loss liability for the University; and provide information on how departments can reduce their claim frequency and severity.
Provide orientation sessions and materials to University staff on University Workers' Compensation Claims policy and procedures.
Interface closely with faculty, staff, and injured parties; University Counsel; outside counsel; University Risk Manager; Campus Risk Manager; medical representatives; University Housing and Operations and Maintenance personnel with regard to settlement discussions, return-to-work programs; and light duty programs.
Other duties and responsibilities appropriate for a Workers' Compensation Claims Specialist position.