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Workers Comp Risk Analyst II

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Accounting & Finance
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JOB SUMMARY

 

Responsible for TPA oversight of YRCWs workers compensation claims in various states.  Works to insure TPA compliance not only with the various state statues as well as TPA compliance with our client service instructions.

 

ESSENTIAL DUTIES AND RESPONSIBILITIES

  1. Works with internal project and support staff as well as external TPA, Attorneys, doctors and vendors to administer the Worker’s Compensation Program.
  2. Manages worker’s compensation claims.   Acts as the day-to-day liaison in worker’s compensation matters.
  3. Analyzes information used in settling claims to ensure claims are settled according to company practices and procedures.
  4. Oversees the day-to-day activities of external program providers including but not limited to: third-party claims administrators, defense counsel, legal bill audit services, and experts.
  5. Ensures claims are thoroughly investigated by the third-party administrator and claim management best practices are followed.
  6. Serves as single point of contact, coordinating with TPA, insurance carriers, claimants, defense counsel and internal clients.
  7. Ensures return-to-work program per organizational policies and federal & state laws; and coordinates effort with the field.
  8. Participates in claims reviews with TPA.  Several times a year.
  9. Reviews and approves reserve recommendations within established authority.
  10. Authorizes defense counsel assignments, approves and coordinates surveillance, and approves Medical Case Management assignments.
  11. Works with adjusters and attorneys on claim resolution strategies and settlement agreements.
  12. Assists Safety Department in selection and management of clinics and providers as mandated by State Law.


COMPETENCIES 

  1. Adaptability - Maintaining effectiveness when experiencing major changes in work responsibilities or environment (e.g., people, processes, structure, or culture); adjusting effectively to change by exploring the benefits, trying new approaches, and collaborating with others to make the change successful.
  2. Building Trusting Relationships - Using appropriate interpersonal styles to establish effective relationships with customers and internal partners; interacting with others in a way that promotes openness and trust and gives them confidence in one’s intentions.
  3. Collaborating - Working cooperatively with others to help a team or work group achieve its goals.
  4. Communication - Conveying information and ideas clearly and concisely to individuals or groups in an engaging manner that help them understand and retain the message; listening actively to others.
  5. Continuous Learning - Actively identifying new areas for learning; regularly creating and taking advantage of learning opportunities; using newly gained knowledge and skill on the job and learning through their application.
  6. Initiating Action - Taking prompt action to accomplish work goals; taking action to achieve results beyond what is required; being proactive.
  7. Work Standards - Setting high standards of performance for self and others; assuming responsibility and accountability for successfully completing assignments or tasks; self-imposing standards of excellence rather than having standards imposed. 

 

MINIMUM REQUIREMENTS

  1. Bachelor’s degree or equivalent educational background or work experience.
  2. Three (3) or more years insurance industry experience in adjusting lost time and PPD workers compensation claims.
  3. Knowledge and experience within the Workers Compensation system, laws and litigation process and investigation techniques.
  4. Effective verbal, written, and interpersonal communication skills.
  5. Demonstrated problem solving and critical thinking skills.  
  6. Detailed oriented with exceptional organizational skills.
  7. Adapts to change and stress in the work environment and manages competing demands while maintaining high performance levels.
  8. Supports change initiatives and ability to build relationships and work collaboratively with a team, internally and externally.
  9. Experience using MS Office applications (Word, Outlook, and Excel).

 

WORKING CONDITIONS

 

This job operates in a professional office environment indoors. Routinely uses standard office equipment such as computers, phones, photocopiers, filing cabinets, and fax machines.

 

PHYSICAL DEMANDS

 

The position requires the ability to spend long hours sitting or standing while using office equipment and computers. Ability to perform repetitive tasks such as typing and keying. Occasional lifting, pushing/pulling, carrying 10 lbs of supplies and materials is required.

 

 

YRC Worldwide is an Equal Opportunity/Affirmative Action Employer
Minorities/Females/Persons with Disabilities/Protected Veterans

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