Responsibilities MV Transportation is seeking a Senior Workers Compensation Risk Analyst to provide Third Party Administration oversight for claims across the organization and is responsible for reporting on the financial impact of these claims to Management and Regional Operations. The Senior WCRA I is also responsible for the claims process management and coordination on policy guidelines, compliance, and the execution of quality assurance inclusive of financial outcomes. This position has no direct reports and reports to the Director of Claims.
Responsibilities: Audit and review a select number of files each month sent to the Management team for review. Communication of process changes from the Workers Compensation department to outside vendors inclusive of education. This includes participation in annual process reviews. The vendor list is inclusive of medical, nurses, PT, RX, attorneys, Broker and the TPA as needed. Execution of all processes ensuring compliance with the Special Handling instructions, State Requirements, Statues and Company policies and standards. Coordinates and executes work with other departments such as Subrogation (recovery and progress), Fraud (pulling needed documentation from files, ensuring surveillance is ordered as requested) Payroll, Field Operations, Legal and Human Resources. Reviews and coordinates all claims activities, along with potential fraud exposures and appropriate action is taken when warranted. If an issue is found, this is escalated up to the Management and/or Director. Completes all department reports to include Sox Payment Review, Denied and Controverted Claims review, Weekly Indemnity Sheets, and all others yet to be defined or as assigned according to department timelines. Prepare and analyze statistical reports and assist in the development of recommendations for improvement to the book assigned. Coordinate with Safety on data collection, prevention, and support. Development and execution of performance metrics and communication of ongoing outcomes as requested from the Management Team. Authorize settlement and reserve requests up to given authority level. Authorize settlement requests greater than $25,000 up to $75,000 regardless of TE in a timely manner from the TPA to submission to Management. Manages TPA performance and completes file dispute log for any items that deviate from our standard practices. Attend monthly status calls or claim "review" strategy sessions as requested or required by Management. Monitor litigation spend according to the submitted budget. Monitor and track recovery for excess carriers, subrogation and state funds or SIF and ensure these are posted to files. Participate in department and outside education opportunities. Participate in department meetings as required inclusive of developing materials or organizing committees. Provide assistance in preparation and distribution of reports as needed. Maintain file retention policies, including control of historical files (record retention). Pull file documentation for Subpoenaed information as well as coordinating discovery requests with Legal. Manage a book of business compromised of state assignments and operation company from the beginning of the claim through conclusion while meeting Department goals. Qualifications Talent Requirements: BA and/or two (2) to five (5) years of WC Adjusting experience. Knowledge of CA Work Comp laws is preferred but not required. Excellent organization skills and communication skills PC Skills Required: need strong skill set in Excel. Demonstrate good project management skills Prior TPA involvement and management a definite plus. Ability to fulfill deadlines Professional presentation skills and attitude. MV Transportation is committed to as policy of Equal Employment Opportunity and will not discriminate against an applicant or employee on the basis of race, color, religion, creed, national origin or ancestry, sex, physical or mental disability, veteran or military status, genetic information or any other legally recognized protected basis under federal, state or local laws, regulations or ordinances.? The information collected by this application is solely to determine suitability for employment, verify identity and maintain employment statistics on applicants.? Where permissible under applicable state and local law, applicants may be subject to a pre-employment drug test and background check after receiving a conditional offer of employment. #CB
