Nordstrom - Costa Mesa, CA
posted about 2 months ago
The Workers Compensation Risk Analyst 3 will be responsible for managing moderately complex claims, including high exposure and litigated claims. This is an intermediate role on the team, not a senior role. Responsibilities include determining benefits due; ensuring management of claims within internal claims management guidelines and in compliance with applicable laws; and identifying opportunities for, managing subrogation of claims, and negotiating settlements. This position is a remote 'work from home' position and must be located in California. A day in the life involves thoroughly investigating workers' compensation claims by timely contacting injured workers, medical providers, and employer representatives/witnesses, and documenting investigation efforts and findings within claim management guidelines. The analyst will determine if claims are valid under applicable workers' compensation statutes and communicate with medical providers to develop and authorize appropriate treatment plans. Additionally, the role requires reviewing and analyzing medical bills to confirm charges and treatment are related to the work injury and in accordance with the treatment plan. The analyst will ensure payments for medical bills and income replacement are remitted on a timely basis in accordance with applicable fee schedules and statutes. They will also calculate and assign appropriate reserves to claims and manage reserve adequacy throughout the life of the claim. Managing claim recoveries, including but not limited to subrogation, second injury fund excess recoveries, and Social Security and Medicare offsets, is also a key responsibility. The position requires preparing required state filings within applicable time limits and overseeing and working with outside counsel to provide information and strategic direction as needed for litigation and/or settlement negotiations. The ability to maintain ongoing education credits in multiple states is also essential.