Blackstone Consulting Workers Compensation Claims Administrator in Los Angeles, California

Description/Job Summary

The Workers Compensation Claims Manager is responsible for administration of workers compensation claims management programs and assists in the mitigating of the company s risk by formulating, developing, reviewing and coordinating claims-related activity. The Workers Compensation Claims Manager reports to the VP of Risk Management. The Workers Compensation Claims Manager s role is to Investigate, analyze, and determine the extent of the company's exposure concerning worker's compensation claims. Candidate is responsible for effectively managing claims files to conclusion, in accordance with applicable statutes and in keeping with company procedures and established performance objectives. The focus of this role centers around producing timely results that are high quality and accurate.

Major Responsibilities Include But Are Not Limited To:

  • Manages and oversees assigned claims on an on-going basis to achieve established goals and objectives.

  • Coordinates and facilitates claim process by acting as a liaison between the insurance carrier/third party administrator, medical provider, broker, site management and the injured employee.

  • Conducts initial incident investigations over the phone by interviewing site contacts, medical providers, agents, witnesses, and claimants to gather information. If there are any apparent red flags, notifies the internal SIU Director.

  • Interprets rules, regulations, and procedures to management and other employees.

  • Interfaces with injured employees.

  • Assist in identifying and interfacing with clinics.

  • Explains benefits and procedures to site management and claimants over the phone and coordinates medical treatments, appointments, and return-to-work opportunities.

  • Utilizes insurance carrier/third party administrator proprietary RMIS (Risk Management Information Systems).

  • Prepares monthly reports by collecting, analyzing, and summarizing information, and enters data/ information into computer, timely and thoroughly.

  • Collaborates with attorneys, medical personnel, and adjusters to gain information for claims management and serves as a resource to defense counsel in the workers compensation claims litigation process

  • Attends hearings, mediations, and file reviews when appropriate.

  • Works closely with the internal SIU Director on suspicious claims.