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Workers Compensation Claims Analyst at Advocate Health · Charlotte
Skills
Job Description
Department:
Status:
Benefits Eligible:
Hours Per Week:
Schedule Details/Additional Information:
Remote position with a preference for the Charlotte, NC area
Fully Remote Role from these states: AL, AK, AR, AZ, DE, FL, GA, IA, ID, IL, IN, LA, KS, KY, ME, MI, MO, MS, MT, NC, ND, NE, NH, NM, NV, OH, OK, PA, SC, SD, TN, TX, UT, VA, WI, WV, WY.
Due to complex requirements, remote work is NOT permitted for short or long periods in: CA, CO, CT, HI, MA, MD, MN, NJ, NY, OR, RI, VT, WA and working Internationally (this includes working while on vacation).
No relocation, No Sponsorship or transfer of visa for this position now or in the future.
Pay Range
$30.70 - $46.05The Workers Compensation Claims Analyst is a critical thinker who manages claims within organizational standards and best practices. They are responsible for the adjudication of medical only claims and limited lost time workers' compensation claims. They will work closely with case managers, attorneys, and vendors. They will manage subrogation liens and negotiate claim settlements to achieve the best possible outcome and support the goals of the department.
Major Responsibilities:
Must possess analytical skills and be able to work with a sense of urgency and accuracy. Must be able to adhere to multiple state workers’ compensation rules, regulations, and laws.
Must be able to complete appropriate contacts within 24 hours of assignment, establish and maintain appropriate diary for follow-up, evaluates and determines compensability of workers’ compensation claims within the statutory period for multiple jurisdictions.
Must be able to be responsible for monitoring and controlling costs, timely documentation of the electronic claim file, claim outcome, timely reserving of files, managing subrogation and litigation, filing appropriate forms and payment of all benefits due within statutory periods and coordinates light duty as needed.
Must function as a resource to the injured teammates, leaders, and others with an interest in the claim.
Must be able to communicate claim status with the injured teammate and other parties, as necessary.
Must be able to develop action plans and strategies for prompt payment/denial of claims bringing them to a timely conclusion while providing all appropriate information. Must be able to monitor and report appropriate claims to excess carriers.
Must be able to determine what treatment is appropriate and causally related to the compensable injury and redirect treatment to network physicians as appropriate. Must be able to promptly authorize and approve related expenses of the claim.
Must be able to maintain strict confidentiality of information at all times of a sensitive nature and/or protected under state and federal law.
Must be able to develop and maintain professional customer relationships. Must be able to provide education as needed and serve as a mentor to other adjusters and stakeholders.
Must be able to provide additional support for additional projects and duties as assigned.
Education Requirements:
Adjusters license for assigned jurisdiction as required by specific jurisdiction as applicable.
Bachelor’s degree required or a combination of education and related experience.
Experience Requirements:
2-5+ years’ experience managing progressively difficult Workers Compensation lost time claims.
Proficiency in MS Office
Preferred:
Associates in Claims designation
Experience with self-insured/ self-administered organizations
Experience with Riskconnect and/or Origami
Knowledge, Skills & Abilities Required:
Must be competent in workers’ compensation rules, regulations, and laws for multiple jurisdictions.
Must work with a sense of urgency and accuracy.
Evaluates and determines compensability of workers’ compensation claims within the statutory limits for multiple jurisdictions.
Must be able to work independently as well as part of a team.
Access to protected Health Information (PHI) to the extent of information necessary to do the job. Information shared only on a need-to-know basis.
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This job description indicates the general nature and level of work expected of the incumbent. It is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities required of the incumbent. Incumbent may be required to perform other related duties.
Our Commitment to You:
Advocate Health offers a comprehensive suite of Total Rewards: benefits and well-being programs, competitive compensation, generous retirement offerings, programs that invest in your career development and so much more – so you can live fully at and away from work, including:
Compensation
- Base compensation listed within the listed pay range based on factors such as qualifications, skills, relevant experience, and/or training
- Premium pay such as shift, on call, and more based on a teammate's job
- Incentive pay for select positions
- Opportunity for annual increases based on performance
Benefits and more
- Paid Time Off programs
- Health and welfare benefits such as medical, dental, vision, life, and Short- and Long-Term Disability
- Flexible Spending Accounts for eligible health care and dependent care expenses
- Family benefits such as adoption assistance and paid parental leave
- Defined contribution retirement plans with employer match and other financial wellness programs
- Educational Assistance Program
About Advocate Health
Advocate Health is the third-largest nonprofit, integrated health system in the United States, created from the combination of Advocate Aurora Health and Atrium Health. Providing care under the names Advocate Health Care in Illinois; Atrium Health in the Carolinas, Georgia and Alabama; and Aurora Health Care in Wisconsin, Advocate Health is a national leader in clinical innovation, health outcomes, consumer experience and value-based care. Headquartered in Charlotte, North Carolina, Advocate Health services nearly 6 million patients and is engaged in hundreds of clinical trials and research studies, with Wake Forest University School of Medicine serving as the academic core of the enterprise. It is nationally recognized for its expertise in cardiology, neurosciences, oncology, pediatrics and rehabilitation, as well as organ transplants, burn treatments and specialized musculoskeletal programs. Advocate Health employs 155,000 teammates across 69 hospitals and over 1,000 care locations, and offers one of the nation’s largest graduate medical education programs with over 2,000 residents and fellows across more than 200 programs. Committed to providing equitable care for all, Advocate Health provides more than $6 billion in annual community benefits.