Job Description
Division: TSIB - Risk Services Project Location(s): Saddle Brook, NJ 07663 USA Minimum Years Experience: 8 Travel Involved: 10-20% Job Type: Regular Job Classification: Experienced Education: Bachelors Degree Job Family: Insurance and Claims Compensation: Salaried Exempt Position Description: Oversee insurance carriers and Third-Party Administrators (TPAs) in their management and handling of clients’ Workers’ Compensation claims in assigned State jurisdictions and geographic region based upon program and compliance regulations. Reports to: Regional Director Essential Duties & Key Responsibilities: Oversee assigned workers’ compensation case portfolio of minor to complex claims in assigned State jurisdictions and geographic region. Leverage knowledge of workers’ compensation policy and manage incidents, and dispatch nurse case managers as necessary. Collaborate closely with Claims leadership and client Risk Management teams on workers’ compensation claims, process, and procedures to ensure integrated program. Serve as resource for injured employees and inform of workers’ compensation process and procedures. Report workers’ compensation claims to carriers and Third-Party Administrators (TPAs), including notification of questionable claims. Facilitate proactive identification of claims with opportunities for early Return to Work and light duty Return to Work program, as needed. Evaluate and respond to Reserve and Settlement Consultations within given authority, escalate consultations above scope authority to appropriate leadership. Maintain diary for open claims and document specific claims related activities in Risk Management information system. Work with carriers, TPAs, and Defense Counsel to develop mitigation strategies for Owner Controlled Insurance Program (OCIP) that result in cost savings to the claim, ensure aggressive strategy is developed on litigated claims, and bring claims to timely resolution. Collaborate with General Liability team to develop mitigation strategies and facilitate most economic global resolution of Contractor Controlled Insurance Program (CCIP) claims. Attend legal proceedings, and mediations on as needed basis. Ensure avenues for potential claim recovery are identified and pursued and manage lien recovery on case-by-case basis. Participate in claims review process and monitor claims handling process by carriers and TPAs; provide direction to ensure compliance with best practices and special handling instructions. Oversee and hold vendors and defense firms accountable for adherence to standard protocols, agreed to service instructions, and litigation management guidelines. Update instructions and guidelines and provide recommendations to appropriate leadership. Partner with Safety team and onsite medics on initiatives that support worker wellness and post-injury care. Participate in CCIP kickoff meetings and jobsite walkthroughs, attend Claims, Safety and Operations meetings to monitor current and anticipated project risks and report on claims status for specific projects. Maintain and foster relationships with carriers and TPAs claims teams. Assist with claim data analysis and claim performance reports. Collaborate with client HR and Payroll departments for completion of required Workers’ Compensation Jurisdictional Forms. Support audits related to workers’ compensation claims. Remain current on Workers’ Compensation laws and regulations, industry trends, and case law within assigned jurisdictions. Other activities, duties, and responsibilities as assigned. NY & NJ Salary Range: $116,750-170,000 (Depending on experience) CT Salary Range: $106,130-150,000 (Depending on experience) Qualifications: Bachelor Degree in Insurance, Risk Management, Finance, Business Administration or related program; with minimum of 8 years of workers’ compensation claims administration experience; or equivalent combination of education, training, and/or experience Experience with workers’ compensation claims in a construction environment, desired CRIS, ARM or similar insurance designation, desired Knowledge of jurisdictional laws and regulations for assigned territory OSHA (Occupational Safety and Health Act) knowledge and experience desired; OSHA 30-hour certification, a plus In-depth knowledge of workers’ compensation claims, medical management procedures, medical cost containment programs and applicable laws and regulations Demonstrate process thinking and sound d