Workers Compensation Specialist Resume Samples

Description :

1. Oversee daily claims management, ensuring compliance with multi-state regulations and company policies.
2. Collaborate with executive leadership to implement effective workers compensation processes across all facilities.
3. Manage medical management and return-to-work programs, ensuring adherence to established protocols.
4. Engage with safety and HR managers to assess incidents and determine claim acceptance or denial.
5. Interface with adjusters, medical professionals, and legal counsel to facilitate claims resolution.
6. Provide monthly forecasts and analysis of workers compensation costs to corporate finance.
7. Develop and deliver training programs for managers on compliance and process improvement.

Experience

10+ Years

Level

Senior

Education

B.S. in BA

Description :

1. Collaborated with employers and insurance carriers to enhance workplace safety programs and compliance.
2. Conducted thorough assessments of employer safety protocols, providing actionable recommendations.
3. Performed on-site audits to ensure adherence to safety standards and regulations.
4. Analyzed claims data to prepare comprehensive risk summary reports, identifying trends and areas for improvement.
5. Led accident investigations, ensuring root cause analysis and effective claim mitigation strategies were implemented.
6. Developed and maintained modified duty programs to facilitate employee return-to-work initiatives.
7. Prepared detailed reports for the state’s cost containment board, highlighting safety improvements and cost savings.

Experience

7-10 Years

Level

Executive

Education

B.S. in BA

Description :

1. Administered the workers compensation program, including injury intake, claims processing, and case record management.
2. Evaluated compensability of injuries and managed payments for temporary and permanent disabilities.
3. Oversaw return-to-work initiatives, assessing modified work availability for injured employees.
4. Collaborated with field offices to resolve inquiries related to injury incidents and claims.
5. Provided timely support to field and TPA staff upon injury notifications.
6. Requested and maintained manual codes from BWC and NCCI for accurate claims processing.
7. Managed injury reporting calls, ensuring prompt triage and response for all incidents.

Experience

2-5 Years

Level

Junior

Education

B.S. in BA

Description :

1. Collaborated with internal teams to ensure thorough investigations of workplace injuries, leading to timely claim resolutions.
2. Maintained detailed documentation of workers' compensation claims, keeping management informed of all developments.
3. Reviewed and adjusted reserves on claims, providing feedback to insurance carriers to optimize financial outcomes.
4. Monitored the performance of adjusters and legal representatives to ensure compliance with company standards.
5. Evaluated claim values and communicated settlement authority, maintaining accurate logs of all settlements.
6. Utilized safety databases to analyze trends and implement solutions that improved claim outcomes.
7. Supported legal teams in litigated claims by preparing necessary documentation and attending legal proceedings.

Experience

2-5 Years

Level

Junior

Education

B.S. in BA

Description :

1. Conduct comprehensive investigations to analyze work-related incidents and determine claim validity.
2. Independently assess claims for benefits, ensuring compliance with regulations.
3. Issue necessary workers' compensation documents within 14-21 days of claim initiation.
4. Manage complex claims involving long-term medical conditions and restricted duty scenarios.
5. Oversee claims in litigation, facilitating reviews, suspensions, and settlements.
6. Evaluate monetary reserves for claims, ensuring adequate coverage for potential liabilities.
7. Foster strong relationships with clients, delivering exceptional customer service throughout the claims process.

Experience

5-7 Years

Level

Executive

Education

B.S. in BA

Description :

1. Contract position as a Workers Compensation Specialist with Express, managing claims from initiation to resolution.
2. Assisted employees with work-related injuries, guiding them through the claims process from the first report to investigation.
3. Reviewed and processed medical bills in collaboration with third-party administrators to ensure timely payments.
4. Provided clear explanations of the workers' compensation process to associates across multiple jurisdictions.
5. Oversaw claim handling procedures on behalf of clients, ensuring compliance with regulations.
6. Managed WC subpoenas and processed leave of absence forms related to workers' compensation claims.
7. Conducted regular audits of claims to identify areas for improvement and ensure accuracy.

Experience

0-2 Years

Level

Entry Level

Education

B.S. in BA

Description :

1. Analyzed and managed complex claims by gathering information to determine exposure and develop action plans for timely resolutions.
2. Reviewed workers compensation accounts against state-mandated guidelines, identifying discrepancies for payment and appeals.
3. Assessed liability and negotiated settlements within designated authority, ensuring compliance with regulations.
4. Calculated and assigned appropriate reserves to claims, managing reserve adequacy throughout the claim lifecycle.
5. Processed and approved timely claim payments, ensuring accuracy and compliance with company policies.
6. Managed litigation processes, ensuring timely and cost-effective resolutions for claims.
7. Utilized cost containment techniques, including vendor partnerships, to reduce overall claims costs for clients.

Experience

2-5 Years

Level

Junior

Education

B.S. in BA

Description :

1. Investigated and processed company-wide workers' compensation claims, ensuring compliance with state regulations.
2. Reviewed loss report forms to verify completeness and validity for claims processing.
3. Gathered statements from witnesses, supervisors, and medical providers to support claims.
4. Determined the necessity of investigations and independent medical examinations for complex cases.
5. Evaluated facts and applied legal standards to recommend approval or denial of claims.
6. Maintained organized files for claims documentation, including data, reserves, and payments.
7. Provided clear explanations of legal requirements and procedures to claimants and stakeholders.

Experience

5-7 Years

Level

Executive

Education

B.S. in BA

Description :

1. Administered a high volume of workers compensation claims, managing an average of 110 open claims weekly across five states, ensuring compliance with state regulations.
2. Collaborated with safety teams and subcontractors for thorough accident investigations and effective claim administration.
3. Communicated with healthcare providers, legal counsel, and insurance representatives to facilitate treatment plans and claim resolutions.
4. Developed and managed a proactive return-to-work program, significantly reducing days lost to injury.
5. Worked closely with management to identify suitable work assignments for employees based on medical restrictions.
6. Conducted investigations to validate claims of occupational injuries, ensuring compliance with company policies.
7. Partnered with safety departments to identify and mitigate potential workplace hazards, enhancing overall safety culture.

Experience

5-7 Years

Level

Executive

Education

B.S. in BA

Description :

1. Ensures timely and accurate processing of workers compensation claims, enhancing operational efficiency.
2. Educates and collaborates with departmental managers to improve claims handling processes.
3. Conducts audits of claims to ensure compliance with policies and procedures.
4. Builds and maintains relationships with departmental liaisons to facilitate effective communication.
5. Implements systems to track and report on claims data, supporting program effectiveness.
6. Analyzes program metrics and generates reports to assess initiative progress and outcomes.
7. Evaluates complex claims to determine benefits, focusing on high-exposure cases and negotiations.

Experience

5-7 Years

Level

Executive

Education

B.S. in BA