Worker's Compensation & Leaves Specialist

Day & Ross•York, PA

2d•Onsite

About The Position

Under the direction of the Manager, Pension & Benefits, NA, the Workers Compensation & Leaves Specialist will perform varied administrative and specialized tasks in support of the day-to-day administration of employee benefit programs, assist with various benefit related issues in accordance with established policies and regulations, while maintaining a very high degree of confidentiality. They will be liaising directly with the Third Party Workers’ Compensation Administrator (TPA) or State Workers’ Compensation Agency (if applicable) to ensure timely processing of workers' compensation claims; evaluates accident reports to determine accuracy and completeness and to ensure adequate investigation; ensure that the claim is in compliance with applicable state laws and regulations, and monitor entire claims life cycle with TPA/State. This position requires a motivated HR professional to support the team and business by fostering a working environment that promotes positive communication, empowerment, development, and support. As a key member of the HR team, you will create the same positive working relationships with our client groups.

Requirements

Post-secondary education, preferably in human resources, or a combination of education and experience.
Training in various federal and state Workers’ Compensation compliance and regulatory laws
Requires 3+ years of experience in medical claims analysis or a related field.
Working knowledge of the Workers' Compensation Act and other applicable state/federal statutes and regulations
Working knowledge of medical terminology, body systems and/or impairments and their disabling effects
Working knowledge of office procedures and files
Ability to obtain facts that ensure that claims information is complete and accurate
Ability to balance/prioritize cases and liaise with TPA as required
Ability to evaluate time-loss claims information to estimate impact
Good judgment in interpreting medical facts presented by a physician and applying these facts in determining an individual's capacity to engage in gainful occupation within the business
Effective communication skills
Ability to maintain satisfactory working relationships with co-workers, the general public and other agency personnel
Strong interpersonal and communication skills (both verbal and written)
Completes work with a high attention to detail and maintain a high level of confidentiality
Ability to multi-task in a fast-paced environment
Strong analytical skills with the ability to collect, organize and analyze information with attention to detail and accuracy.
English is required, other languages an asset
Independent contributor, able to work with little supervision.
No direct reports.

Nice To Haves

Medical course work preferred.
Training in DOT/OSHA compliance preferred
Registered Nurse (RN) designation or nursing background considered a strong asset.

Responsibilities

Work collaboratively with third party administrators (TPA’s) to ensure reasonable responses to concerns and accuracy in the application of the policy and challenge when required.
Works with Managers and Employees to initiate workers’ compensation claims with TPA.
Facilitates State-owned Workers’ Compensation cases as needed in monopolistic states (North Dakota, Ohio, Washington, and Wyoming).
Liaises with TPA/State Case Agents, and Human Resources Partners to review Workers’ Compensation cases and accommodations.
Evaluates accident reports, department investigation results and other documentation.
Compile facts and data regarding accident reports and filed cases to support reporting to TPA/state.
Provides information and notices of return to work in accordance with local, state and federal regulations and the Workers' Compensation Act.
Liaises with TPA/State to coordinate return-to-work programs and activities and ensures accommodations are met when applicable.
Oversee and administer leaves requests and short-term disability claims in conjunction with TPA
Maintains knowledge of all applicable leave and accommodation laws including the FMLA, ADA and state and local laws
Attends trainings and seminars, conducts research and maintains liaison relationship with TPA/State Agencies to stay in compliance with changing laws and trends.
Other duties and projects as assigned.