YMCA of San Diego County

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Workers’ Compensation & Claims Specialist

at YMCA of San Diego County

Posted: 10/2/2019
Job Status: Full Time
Job Reference #: 12490
Keywords: insurance, claims

Job Description

The Workers’ Compensation & Claims Specialist is responsible for managing our self-insured workers’ compensation program and acting as claims analyst for all claims. The Specialist will review and analyze claim details and expenses, prepare reports, processing new claims and completing old ones, and maintaining a focus on compliance to applicable laws and regulations. The Specialist will develop successful partnerships between YMCA staff, third party administrators (TPAs), internal business partners and stakeholders, and external service providers.

What we look for in a Workers’ Compensation & Claims Specialist...

  • Minimum 3 years’ experience in workers’ compensation, general liability and auto claims
  • Bachelor’s degree or equivalent experience is required
  • Knowledge of insurance industry, preferably claims management
  • Data management skills and ability to use data to effectively influence decisions
  • Proficient in Microsoft Office and general office equipment
  • Strong attention to detail and ability to manage multiple, competing deadlines simultaneously
  • Ability to communicate effectively both verbally and in writing
  • Ability to maintain confidentially
  • Visual and auditory ability to respond to critical incidents and the physical ability to act swiftly in an emergency situation
  • Certifications such as CWCP, RWCS, WCCA or similar strongly preferred
  • Ability to travel to YMCA branches throughout San Diego County
  • Bilingual English/Spanish strongly preferred

What a Workers’ Compensation & Claims Specialist does...

  • Manages Workers comp program, claims, and audits and compiles statistics to prepare reports of claims
  • Handles general liability and claims portfolio to cost-effective closure.
  • Acts as point of contact for staff regarding any work-related incident, illness, or injury that could or has resulted in a Workers’ Compensation claim
  • Works closely with branch staff and HR regarding work injuries, and conducts injury/illness investigations
  • Acts as point of contact and evaluates accident reports, ensuring the timely processing of medical bills and temporary total disability benefits; reviews medical reports, witness statements, department investigation results, and other documentation
  • Analyzes and reviews high exposure claims and litigation in partnership with the legal department, third party claims administrators, insurance and Human Resources
  • Ensures confidentiality of Worker’s comp claims records; including relevant health information related to the claim; maintains consistent uniform records for each claim; where applicable, ensures all appropriate authorization and forms are signed and processed
  • Ensures that the TPA manages the claims diligently, partners with management and Legal resources to manage relevant claim details, implements plan for timely resolution of claims; reviews claims together with TPA for causation and possible subrogation opportunities
  • Partner with multiple departments to coordinate and manage Return-to-Work programs for employees to ensure that work guidelines are being adhered to provide transitional work letter to staff
  • Maintains subrogation records and files for those incidents involving third parties
  • Compiles facts and data regarding accident reports and filed cases
  • Communicates all relevant documentation regarding work-related incidents to Safety department, healthcare providers, Leave of Absence (LOA) team and TPA
  • Interfaces with physicians, attorneys, and management staff; coordinates return-to-work plans; coordinates and monitors rehabilitation plans for injured employees; evaluates results of return-to-work medical examinations and makes appropriate determinations
  • Advises and/or assists departments in conducting investigations of accident reports, including interviewing of witnesses and procurement of relevant documentation
  • Reviews accident reports to identifies patterns of injury to determine potential unsafe conditions; advises departments of trends in injuries and proper safety procedures that may result in the reduction of injuries; provides the department with information that will aid in reducing accidents and improve safety
  • Trains staff in the proper procedures and forms to be utilized in workers' compensation matters and the preparation of accident reports, notices of absence, and notices of return to work
  • Documents telephone conversations, witness statements, medical reports, accident investigation results, and payment of medical bills; prepares summaries of medical reports
  • Provide initial notice of claims to third party vendor
  • Analyze claims data for trends, cost-saving opportunities
  • Schedule, develop agenda and host all conference calls and claim reviews with TPA
  • Monitors liability claims from start to finish, verifying and updating information on submitted claims, negotiate payment to all parties and following up to ensure that payments are made


Application Instructions

Please click on the link below to apply for this position. A new window will open and direct you to apply at our corporate careers page. We look forward to hearing from you!