Claims Analyst in East Syracuse NY

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Dairy Farmers of America
Claims Analyst
Job ID: 
East Syracuse NY
Not Specified
Not Specified
Job Types:
Credit Analyst/Manager, Financial Analyst
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Working closely with the Claims Manager, this position is responsible for ensuring quality claim handling. Perform all activities related to handling of loss time claims arising from accidents, including investigation, compensability determination, management of medical treatment, and resolution. Settle all claims within defined authority. Serve as point of contact for members to report claims and address issues and concerns. Function as key point of contact with third-party administrator (TPA) and external claim handlers to ensure proper resolution of claims. Gather pertinent data from TPA and Workers&##39; Compensation system to perform analysis to generate trend reports, provide detail for stewardship presentations and develop recommendations to management.

  • Oversee handling of 200+ workers&##39; compensation claims for over 25 states
  • Directly responsible for appropriate and timely settlement of all claims with a total incurred value up to $750,000; work with external claim handler to analyze and investigate complex/technically difficult claims; secure all pertinent information to determine claim exposure, manage claims process through well-developed action plans, provide settlement authorization and resolve claims appropriately and within established timeframes
  • Investigate loss time claims arising from an accident to determine compensability and manage medical treatment
  • Formulate effective and appropriate claim resolution strategies to resolve claims within established timeframes; promote proactive return to work and transitional duty; evaluate and negotiate claim settlements
  • Coordinate a minimum of three claim review/audits annually to ensure proper and proactive claim management with a focus on providing quality medical care to injured workers and long-term cost mitigation; track results of each review/audit to ensure proper adjuster follow-up and resolution efforts
  • Administer deductible billing process for all insured clients with deductible policies; ensure required payments are made to TPA and properly applied to claims
  • Maintain TPA special handling guidelines, ensuring annual updates are incorporated and process and procedures are compliant
  • Collect, analyze, evaluate and synthesize all data necessary to supply management with a) claims data for stewardship presentations, b) identification of claims trends and c) the development of financial and claims projections; work with TPA to resolve unlinked claims in timely manner
  • Obtain TPA annual System and Organization Controls (SOCI) report and share with management
  • Prepare and present claim introduction letters, executive claim summary letters and claim stewardship reports
  • The requirements herein are intended to describe the general nature and level of work performed by employee, but is not a complete list of responsibilities, duties, and skills required. Other duties may be assigned as required.

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