Case Manager I, Workers' Compensation
Benton County, AR
Demonstrates up-to-date expertise and applies this to the development, execution, and improvement of action plans by providing expert advice and guidance to others in the application of information and best practices; supporting and aligning efforts to meet customer and business needs; and building commitment for perspectives and rationales. Provides and supports the implementation of business solutions by building relationships and partnerships with key stakeholders; identifying business needs; determining and carrying out necessary processes and practices; monitoring progress and results; recognizing and capitalizing on improvement opportunities; and adapting to competing demands, organizational changes, and new responsibilities. Models compliance with company policies and procedures and supports company standards of ethics and integrity by incorporating these into the development and implementation of business plans; using the Open Door Policy; and demonstrating and assisting others with how to apply these in executing business processes and practices.
What you'll do...
Manages moderately complex workers' compensation claims by investigating facts of the case; determining compensability; evaluating medical records and physician recommendations; utilizing medical and legal resources; communicating with physicians to seek clarification or to question medical treatment; obtaining independent medical examinations; identifying preexisting injury or possibility of fraud; utilizing appropriate business writing techniques in reviewing, documenting, and indexing information and mail within the claim management system; reviewing potential settlements; determining probable exposure if any; and establishing appropriate reserves.
Monitors associate disability management to ensure costs are appropriate by tracking serious injuries and recovery; analyzing exposure; compiling and reviewing documents and evidence; evaluating back-to-work issues; developing back-to-work action plans with physicians and store staff; negotiating with injured associates and legal or state board representatives; requesting medical records and billing documents; determining if payment is warranted to medical providers and/or injured associates; and ensuring payment is made.
Manages monetary aspects of assigned claims by establishing appropriate reserves and authorizing payment or facilitating denial of the claim; engaging in negotiations with minimal supervision.
Participates in moderately complex case reviews by reviewing files; summarizing facts; completing standardized forms; identifying legal issues; presenting claim information and possible exposure to senior management; offering recommendations to address issues, settlements, and reserve changes; and occasionally participating in depositions and arbitrations.
Provides service to customers by sharing information; discussing resolution strategies with counsel; developing relationships with support areas; and providing guidance or suggestions to customers on alternate strategies, reserve assessment, and how to handle complex situations.
Outlined below are the required minimum qualifications for this position. If none are listed, there are no minimum qualifications.
Minimum Qualifications: Insurance Adjuster license OR will obtain an Insurance Adjuster license within 90 days of job entry date.
Outlined below are the optional preferred qualifications for this position. If none are listed, there are no preferred qualifications.
Customer Service, InsuranceBachelors: Arts, Bachelors: Science