Senior Workers Compensation Risk Analyst
Company: MV Transportation
Location: Dallas
Posted on: April 26, 2024
Job Description:
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
Keywords: MV Transportation, Grand Prairie , Senior Workers Compensation Risk Analyst, Professions , Dallas, Texas
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