287567 - Workers Compensation Plant Rep II

  • Post Date:January 14, 2022
  • Apply Before: January 14, 2023
  • Views 16
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Job Description

Act as the primary plant Workers’ Compensation claims handler through contact and coordination of robust RTW/Communications efforts with all stakeholders for the Company Workers’ Compensation program. Focus on excellent customer service, quality claims handling, and loss cost management UPDATED 12/6/21: • Primary Workers’ Compensation Claims Handler at the Plant with a focus on excellent customer service, quality claims handling, and loss cost management.
Skills Required:
•Administration and Management of Indemnity& Managed Medical and Legal claims from first report of injury through claim closure (Includes compliance with Guidelines and Standards and any other associated Corporate policies and procedures) •Perform critical plant Claims technical tasks (i.e. initial critical investigations (including 3pt contact), contact with plant medical, safety/ergonomic, plant supervision) •Develops R-T-W plan of action with key stakeholders for WC and related absences •Participates in plant job reviews with plant physician and other stakeholders •Liaison between key plant personnel/and Workers’ Compensation Organizations throughout Ford Motor Company Case Management process •Leads Case Management meetings and provides input/guidance on RTW •Communicates issues, opportunities, and concerns to Division Claims Supervisor •Update plant personnel on WC jurisdictional changes •Coordinate and direct efforts of outside Medical Case Managers and Vocational Rehabilitation Specialist to deliver best possible outcome •Assist with identification and documentation of potential modified duty jobs, as appropriate •Assist in management of all financial elements of claim files to reduce or maintain costs (i.e. medical costs, duration). •Provide ongoing communication with key stakeholders •Monitor and assist restricted employees in returning to full duty at same or different job •Manage all activities according to personal metrics and performance standards.
Skills Preferred:
• Analyze and process complex or technically difficult workers’ compensation claims by investigating and gathering information to determine the exposure on the claim • Ability to handle a full case load, with proven ability to handle cases of increased severity. • Workers’ Compensation Lost Time claim handling experience • Manage claims through well-developed action plans to ensure timely and cost effective resolutions.
Experience Required:
•3-5 years of workers’ compensation claims handling. Licensed Kentucky adjuster • Calculate and assign timely and appropriate reserves to claims; manages reserve adequacy throughout the life of the claim. • Calculate and pay benefits due; approve and make timely claim payments and adjustments; and settle clams within designated authority level. • Prepare necessary state fillings within statutory limits. • Coordinate vendor referrals for additional investigation and/or litigation management. • Use appropriate cost containment techniques including strategic vendor partnerships to reduce overall cost of claims. • Manage claim recoveries, including but not limited to: subrogation, Second Injury Fund excess recoveries and Social Security and Medicare offsets. • Report claims to the excess carrier. • Communicate claim activity and processing with the claimant and the client. • Ensure claim files are properly documented and claims coding is correct. • Refer cases as appropriate to supervisor and management. • Excellent oral and written communication skills. • PC literate, including Microsoft Office products. • Analytical and interpretive skills. • Strong organizational skills. • Good interpersonal skills. • Excellent negotiation skills. • Ability to work in a team environment.
Experience Preferred:
****UPDATE – 9/27/2021****willing to accept a non-licensed candidate with minimal experience in medical and/or Workers’ Compensation with the expectation that they would be willing to take the adjuster licensing course, when hired
Education Required:
College preferred or equivalent industry experience.
Education Preferred:
• College degree and 3 years of claims management experience or equivalent combination of education and experience preferred. • High school diploma and 3 years related claims experience accepted. • Appropriately licensed and/or certified in all states in which claims are being handled – Kentucky
Additional Safety Training/Licensing/Personal Protection Requirements:
Additional Information :
• Extensive knowledge of accepted industry standards and practices. • Computer experience with related claims and business software.
6-Dec-2021 OPN Version 1.0