Workers Compensation, Risk Analyst 3 (Hybrid)

Nordstrom•Fullerton, CA

14h•Hybrid

About The Position

The Workers Compensation Risk Analyst 3 will be responsible for managing moderately complex claims, including high exposure and litigated claims. Responsibilities include: determining benefits due; ensuring management of claims within internal claims management guidelines and in compliance applicable laws; and identifying opportunities for and managing subrogation of claims and negotiating settlements. This is an intermediate claims examiner position that reports directly to the Risk Claims Supervisor. This position operates in a hybrid work environment, requiring regular in office attendance (currently expected to be 4 days a week with an option to work from home 1 day per week).

Requirements

High school diploma or general education degree (GED) and two years of workers’ compensation claims handling experience required.
Strong understanding of workers’ compensation laws and regulations as well as workers’ compensation claim principles and application.
Strong verbal and written communication and negotiation skills.
Ability to work positively and collaboratively in a team environment; must always use good judgment
Excellent time management and organizational skills
High level of attention to details while working in a fast-paced environment
Frequent use of computers, telephones, and other standard office equipment

Nice To Haves

Bachelor's degree from four-year college or university preferred.
IEA Certificate, California Self Insured Certificate preferred.

Responsibilities

Thoroughly investigate workers’ compensation claims by timely contacting injured workers, medical providers, and employer representatives/witnesses and documenting investigation efforts and findings within claim management guidelines
Determine if claims are valid under applicable workers’ compensation statutes.
Communicate with medical providers to develop and authorize appropriate treatment plans.
Manage time loss claims with proactive efforts for early return to work.
Review and analyze medical bills to confirm charges and treatment are related to the work injury and in accordance with the treatment plan.
Ensure payments for medical bills and income replacement are remitted on a timely basis in accordance with applicable fee schedules and statutes.
Calculate and assign appropriate reserves to claims and manage reserve adequacy throughout the life of the claim.
Manage claim recoveries, including but not limited to subrogation, Second Injury Fund excess recoveries, and Social Security and Medicare offsets.
Prepare required state filings within statutory limits.
Oversee and work with outside counsel to provide information and strategic direction as needed for litigation and/or settlement negotiations
Report to the office on scheduled in-office days to support real-time collaboration with the claims team and supervisor on complex and litigated claims; this in-office presence is an essential function of the role.
Ability to maintain on-going education credits in a multitude of states.
Manage claims across multiple state jurisdictions (currently 18 states handled in-house), each with distinct statutory and regulatory requirements.