WC Claims Specialist

Overview

Manages workers' comp claims, training, and compliance.

Key Responsibilities

• claim management
• policy updates
• field liaison
• medical billing
• trend reporting
• training delivery

Tasks

-May assist with policy updates for related areas of responsibility -Assists with updating documentation and communication associated with related leaves of absences -Serves as primary contact for the field operations on WC related claim procedures and claims management issues -Acts as a liaison between injured worker and TPA/carrier -Reviews claim data to ensure that claims are managed, paid, and resolved according to service criteria -Assists in developing legal strategy for each litigated case -Assists with monitoring federal and state leave regulations and with working with vendors and plants to implement any necessary updates to existing procedures -Provides guidance and related training to plant personnel with work comp responsibilities -May serve as backup for other various safety related program administration -Ensures that all claims are reviewed for appropriateness of acceptance or denial -Helps maintain documentation, legal evidence, and other related file administration -Advises the field and claim managers/TPA in investigating aspects of serious or questionable claims -Advises the field in transitional and long-term return-to-work strategies -May serve as backup for Substance Abuse policy administration -Ensures that the claim managers/TPA pay medical bills and other related invoices promptly -May serve as a back-up for FMLA, ADA, and disability related claim procedures and claims management issues -Maintains updated knowledge of state comp laws or other legal changes impacting areas of responsibility -Monitors claim activity to ensure timely and accurate delivery of benefits -Assists in the identification of legal counsel with assistance from the claim managers/TPA -May assist with training for other related areas of responsibility -Provides assistance to the field regarding medical management and return to work -Trains new plant HR/safety personnel, including acquisitions, on related leave of absence procedures -Assists with providing information to TPA/legal counsel in response to subpoena requests -Prepares and participates in strategic claim resolution meetings -Advises the field in identifying and maintaining quality medical providers -Produces quarterly trend reports and other related reports as requested

Requirements

• advanced excel
• claims management
• bachelor's
• medical terminology
• confidentiality
• problem solving

What You Bring

-Ability to coordinate and prioritize case load -Ability to maintain and safeguard confidential information -Demonstrated ability to use computers and related business software and experience with advanced excel or other report writing programs -Ability to solve problems and apply knowledge and education in complex situations -Ability to understand, analyze, and communicate financial information as a management tool -Formal, working knowledge of claims management protocol and related employment law -Verbal and written skills with the ability to communicate at all levels within the organization -Some knowledge and understanding of medical terminology -Interpersonal and problem-solving skills -Bachelor’s degree or equivalent experience in a related field -Ability to travel as required

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About Ufp Industries

-It serves builders, manufacturers, and big-box retailers with products ranging from engineered lumber to custom packaging systems. -By operating as North America’s largest softwood converter and global pressure-treat leader, it gains scale and sourcing advantages. -It delivers for residential, commercial, industrial, and packaging customers through hundreds of facilities across several continents. -Notable projects include custom truss systems, composite decking brands, and ISTA-certified packaging labs.

Sector Specialisms