Workers' Compensation Claims Analyst

Department:

Status:

Benefits Eligible:

Hours Per Week:

Schedule Details/Additional Information:

Business hours are Monday-Friday working 8-5pm. The position is primarily remote, but will be required to attend in-person meetings in Oak Brook, IL on occasion.

Pay Range:

The Workers Compensation Claims Analyst is a critical thinker who manages claims within organizational standards and best practices. They are responsible for the adjudication of medical only claims and limited lost time workers' compensation claims. They will work closely with case managers, attorneys, and vendors. They will manage subrogation liens and negotiate claim settlements to achieve the best possible outcome and support the goals of the department.

Major Responsibilities:

• Mustpossessanalytical skills and be able to work with a sense of urgency andaccuracy. Must be able to adhereto multiple state workers’ compensation rules, regulations,and laws.
• Must be able to completeappropriatecontactswithin24hoursofassignment,establishand maintain appropriate diaryforfollow-up, evaluates and determinescompensability of workers’ compensation claims withinthestatutoryperiodformultiplejurisdictions.
• Must be able to be responsible formonitoring and controlling costs, timelydocumentation of the electronic claim file, claim outcome, timelyreserving of files, managing subrogation and litigation, filing appropriate formsand payment of all benefits due within statutory periods and coordinates light duty as needed.
• Must function asa resource totheinjured teammates, leaders,and others with an interest in the claim.
• Must be able tocommunicate claim status with the injured teammate and other parties,as necessary.
• Must be able to develop action plans and strategies for prompt payment/denial of claims bringingthem to atimelyconclusion while providing all appropriate information. Must be able to monitorand report appropriate claimsto excess carriers.
• Must be able to determinewhat treatment is appropriateand causally related to the compensable injuryand redirect treatment to network physicians as appropriate. Must be able to promptly authorize and approve related expenses of the claim.
• Must be able to maintainstrict confidentiality of information at all times of a sensitivenature and/or protected under state and federallaw.
• Must be able to develop and maintainprofessional customer relationships. Must be able to provide education as needed and serve as a mentor to other adjusters and stakeholders.
• Must be able to provide additionalsupport for additionalprojects and duties as assigned.

Education Requirements:

• Adjusterslicense for assigned jurisdictionas required by specific jurisdictionas applicable.
• Bachelor’sdegree requiredor a combination of education and related experience.

Experience Requirements:

• 2-5+ years’ experience managingprogressively difficultWorkers Compensation lost time claims. Associates in Claims designation preferred.

Knowledge, Skills & Abilities Required:

• Must be competent in workers’ compensation rules, regulations,and laws for multiple jurisdictions.
• Must work with a sense of urgency and accuracy.
• Evaluates and determinescompensability of workers’ compensation claims within the statutory limitsfor multiple jurisdictions.
• Must be able to work independently as well as part of a team.
• Access to protected Health Information (PHI) to the extent of information necessary to do the job. Information shared only on a need-to-know basis.

This job description indicates the general nature and level of work expected of the incumbent. It is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities required of the incumbent. Incumbent may be required to perform other related duties.

Our Commitment to You:

Advocate Health offers a comprehensive suite of Total Rewards: benefits and well-being programs, competitive compensation, generous retirement offerings, programs that invest in your career development and so much more - so you can live fully at and away from work, including:

Compensation

• Base compensation listed within the listed pay range based on factors such as qualifications, skills, relevant experience, and/or training

• Premium pay such as shift, on call, and more based on a teammate's job

• Incentive pay for select positions

• Opportunity for annual increases based on performance

Benefits and more

• Paid Time Off programs

• Health and welfare benefits such as medical, dental, vision, life, and Short- and Long-Term Disability

• Flexible Spending Accounts for eligible health care and dependent care expenses

• Family benefits such as adoption assistance and paid parental leave

• Defined contribution retirement plans with employer match and other financial wellness programs

• Educational Assistance Program

Note: Eligibility for programs listed above may depend on your FTE or status (e.g., full-time, part-time, per diem, temporary, etc.); please ask a Recruiter for more information during an interview.

About Advocate Health

Advocate Health is the third-largest nonprofit, integrated health system in the United States, created from the combination of Advocate Aurora Health and Atrium Health. Providing care under the names Advocate Health Care in Illinois; Atrium Health in the Carolinas, Georgia and Alabama; and Aurora Health Care in Wisconsin, Advocate Health is a national leader in clinical innovation, health outcomes, consumer experience and value-based care. Headquartered in Charlotte, North Carolina, Advocate Health services nearly 6 million patients and is engaged in hundreds of clinical trials and research studies, with Wake Forest University School of Medicine serving as the academic core of the enterprise. It is nationally recognized for its expertise in cardiology, neurosciences, oncology, pediatrics and rehabilitation, as well as organ transplants, burn treatments and specialized musculoskeletal programs. Advocate Health employs 155,000 teammates across 69 hospitals and over 1,000 care locations, and offers one of the nation’s largest graduate medical education programs with over 2,000 residents and fellows across more than 200 programs. Committed to providing equitable care for all, Advocate Health provides more than $6 billion in annual community benefits.