Sr Risk Management Analyst

Summary: 

The Sr Risk Management Analyst is responsible for providing oversight to HMSHost Workers’ Compensation claims and acting as a liaison between Third Party Administrators and field operations. The position will also be responsible for providing field training on various aspects of safety and Workers Compensation compliance; and performing all other responsibilities as directed by the business or as assigned by management.  

This is an exempt position and reports to the Director Risk Management. 

Essential Functions: 

• Provides direction as necessary to drive claims to a timely and appropriate resolution through appropriate compensability determination, reserving, and settlement evaluation. 

• Monitors Third Party Claims Administrators expenses regarding assignment of outside claim 

• investigators, Nurse Case Management, Physician Reviews, Medicare/SCHIP Set-Asides. 

• Directs field management on claim reporting, claim management and return-to- work procedures. 

• Coordinates complex claim resolution with the Legal Department; including claims that have an ADA, EEOC or FMLA component to the Worker’s Compensation claim. 

• Provides oversight of Third-Party Administrator by conducting annual claim reviews, audits and other claim related projects. 

• Manages State Funded Workers’ Compensation (Ohio and Washington State) oversight vendor 

• regarding uploads to Third Party Administers claim system, quarterly premium payments, and outside attorney assignment and expenses. 

• Identifies claim trends and recommend training programs, procedures or actions to reduce claim costs. 

• Develops and maintains state required in-network physician panels. 

• Assists the Director Risk Management to achieve Risk Management goals. 

• Monitors 24/7 Nurse Triage program and encourages location participation. 

• Updates knowledge base on claim practices, case law and industry claim trends. 

Minimum Qualifications, Knowledge, Skills, and Work Environment: 

• Requires a Bachelor’s degree or related experience 

• Requires 5 years technical claims experience with a carrier or TPA; preferably with working knowledge of a multi-location service industry’s business and associate needs 

• Requires knowledge of state-specific Workers’ Compensation regulations and understanding of technical claims procedures, medical protocols and best practices 

• Requires proficiency in Microsoft Office and other Claim Management Systems 

• Requires demonstrated attention to detail, good time management, prioritization skills, project 

• management and organization skills 

• Requires excellent logical thinking, analytical, and problem-solving skills 

• Requires a strong team player able to handle multiple tasks in tight timeframes with minimal supervision 

• Requires the ability to use discretion and understand confidentiality issues 

• Requires excellent oral, written, and interpersonal skills