Claims Administrator

: Description

A Brief Overview

This position is responsible for receiving, processing, reviewing and maintaining all disability claim information (workers' compensation and short term disability).

What You Will Do

• Performing claims administration and adjusting of the workers' compensation or short term disability claims for UH and its subsidiary and partnership entities. Claims administration includes: reviewing all claim applications and reports; making a decision on approval or rejection of benefits; analyzing data on the application, medical records, supervisor reports and other supporting data; making decisions using industry standards; and, processing and maintaining internal documentation as necessary within corporate and industry guidelines.
• Performing ongoing management of claims from cradle to grave, which includes: investigating, evaluating and settling claims (settlement applies to workers' compensation only); and, applying technical knowledge and human relations skills to effect fair and prompt disposal of cases and to contribute to a reduction in claim losses.
• Entering/Review claim payments and set reserves within authority level and corporate policy on open claims.
• Collaborating with WCS clinical case manager to determine the claim allowance and duration of disability fall within industry standards and best practices.
• Under the direction of the WCS Manager, conferring with the Legal and Human Resources departments on claim issues that fall under FMLA or ADA protection. Partner with Corporate Health, Human Resources and the Legal Department to return employees to transitional duty when possible.
• Preparing loss run reports as needed.

Additional Responsibilities

• Performs other duties as assigned.
• Complies with all policies and standards.
• For specific duties and responsibilities, refer to documentation provided by the department during orientation.
• Must abide by all requirements to safely and securely maintain Protected Health Information (PHI) for our patients. Annual training, the UH Code of Conduct and UH policies and procedures are in place to address appropriate use of PHI in the workplace.

Qualifications

Education

• High School Equivalent / GED (Required)
• Associate's Degree (Preferred)

Work Experience

• 3+ years of work experience relating to TPA, Insurance company, paralegal or self-administered employer experience in Ohio self-insured workers' compensation and/or non-occupational disability management. (Required)

Knowledge, Skills, & Abilities

• Fluent knowledge of BWC rules and regulations. (Required proficiency)
• Understanding of the hearing and appeal process through the administrative level and into court. (Preferred proficiency)
• Proficiency with multi-line telecommunications systems, facsimile, and photocopy equipment. (Required proficiency)
• Proficiency with personal computer (Windows/Microsoft office). (Required proficiency)
• Ability to work unsupervised, under pressure. (Required proficiency)
• Ability to handle multiple tasks and projects simultaneously with constant interruptions (Required proficiency)
• Excellent oral and written communication skills. (Required proficiency)
• Demonstrated ability to work in team environment. (Required proficiency)

Physical Demands

• Standing Occasionally
• Walking Occasionally
• Sitting Constantly
• Lifting Rarely 20 lbs
• Carrying Rarely 20 lbs
• Pushing Rarely 20 lbs
• Pulling Rarely 20 lbs
• Climbing Rarely 20 lbs
• Balancing Rarely
• Stooping Rarely
• Kneeling Rarely
• Crouching Rarely
• Crawling Rarely
• Reaching Rarely
• Handling Occasionally
• Grasping Occasionally
• Feeling Rarely
• Talking Constantly
• Hearing Constantly
• Repetitive Motions Frequently
• Eye/Hand/Foot Coordination Frequently

Travel Requirements

• 10%