Workers Compensation Claims Analyst

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Job Profile Title:

Workers Compensation Claims Analyst

Job Code:

12114

Profile Title:

12114 Workers Compensation Claims Analyst

Grade / Band:

IC3

FLSA Status:

Exempt

The primary purpose of the Workers' Compensation Claim analyst is to oversee the company's Nevada, Michigan, Ohio, Massachusetts, Maryland, New York, New Jersey and Mississippi Workers' Compensation claims handled by Third Party Administrators and act as a liaison between the company's domestic properties and the TPA adjusters to ensure the investigation and administration of all claims is completed and appropriate. The Workers' Compensation Claim Analyst also provides alerts to the Director of Workers' Compensation on claims with significant financial impact, maintains updated OSHA logs and provides proactive communication to injured workers.

Manage and serve as the company claim advocate for Worker's Compensation claims administered by TPAs nationwide.

Serve as the primary key contact with the TPAs, MGM department leaders, and the injured worker to ensure timely and appropriate administration of claims.

Supervise TPA administration for quality assurance, appropriate claim management, control of medical management services, and oversight of litigation expenses.

Carryout oversight and audit processes to monitor the TPA's adherence to their Best Practices and agreed upon Special Handling Instructions.

Oversee Worker's Compensation claims the handling of the Companies Nevada, Michigan, Ohio, Massachusetts, Maryland, New York, New Jersey and Mississippi Workers' Compensation claims reviewing notes in TPA Risk Management Systems including, but not limited to, data entry, claim reporting, appropriate medical management, reserving, timely claimant communication, documentation, litigation, settlement negotiations, and return to work protocol.

Works closely with the Director of Worker's Compensation in identifying trends and areas for program improvement.

Conduct and facilitate claim reviews on a quarterly basis with the TPA adjusters to ensure TPA compliance with MGM requirements and quality assurance standards.

Oversight of the TPA adjuster files for proper evidence and a plan for case resolution.

Identify cases that should resolve and work with the adjuster to resolve at the earliest opportunity.

Establishes a cadence of regular interactions with key TPA claims personnel to ensure alignment of expectations and strengthening of the partnership.

Works collaboratively with the TPA claims handlers to develop strategies for cost containment and claim resolution.

Responsible for collaborating with Company Return to Work Specialists and ADA Department to follow corporate guidelines regarding permanent restriction processes.

Provide education and training to departments as needed, aimed to reduce frequency of injuries.

Serve as a resource to the injured employee to assist in navigation of the Work Comp claims process.

Weekly management of Work Comp claims system in order to supply relevant data to OSHA 300 and 301 logs, in coloration with the Safety Department, to ensure compliance with all federal, state, and local reporting requirements.

Remains up to date of worker's compensation regulations, laws and ruling.

Other projects and tasks as necessary and required by the Director of Worker's Compensation, VP of Risk Management, and other Risk Management department leaders.

Performs other job-related duties as requested

Proof of eligibility to work in the United States

High School Diploma or GED

Required

Bachelor's Degree

Preferred

3+ Years of Prior Relevant Experience

Working for a public company in the State of Nevada

Required

Nevada State Worker's Compensation license

Preferred

Previous experience working in a similar resort setting

Preferred

Excellent oral communication in speaking to others to convey information effectively.

Skilled at various software including Word, Excel and PowerPoint, and analytics software.

Strong reading, written comprehension as well as writing skills

Balancing

X

Bending

X

Carrying 10 pounds

X

Clear speech - simple

X

Clear speech - complex

X

Climbing

X

Distant vision

X

Driving

X

Flexibility - upper body

X

Flexibility - lower body

X

Hearing/Listening

X

Kneeling

X

Lifting 10 pounds

X

Near vision

X

Normal vision

X

Pushing/Pulling

X

Reaching

X

Sitting

X

Standing

X

Typing

X

Walking

X

Communication - verbal

X

Communication - written

X

Confined area

X

Contacts - works alone

X

Contacts - works around others

X

Contacts - works with others

X

Exposure to dust / dirt

X

Exposure to fumes / odors

X

Extreme cold

X

Extreme heat

X

Fast pace

X

Hazardous conditions - chemicals

X

Hazardous conditions - high structures

X

Hazardous conditions - high voltage

X

Indoors

X

Noise levels - low to moderate

X

Noise levels - high

X

Office conditions

X

Outdoors

X

Restricted area

X

Shifts

X

Smoke

X

Travel

X

Wet/Humid

X

Analytical

X

Clerical

X

Comprehension

X

Crisis incidents

X

Customer service

X

Decision making

X

High pressure

X

Judgment

X

Long hours

X

Math skills - advance

X

Math skills - basic

X

Organization

X

Reading - simple

X

Reading - complex

X

Repetition

X

Tight deadlines

X

Writing - simple

X

Writing - complex

X