Sr Claims Administrator

What You Will Do

• Evaluates and makes decision on the certification or rejection of all new and existing lost time and/ or contested Workers' Compensation (WC) claims pursuant to department procedures and Ohio Bureau of Workers' Compensation (BWC) regulations.
• Ensures DMS department Workers' Compensation Claims Administrator/Examiner and Medical Claims Processor are accurately and timely completing claims; engages Director as needed to address performance issues. Serves as WC subject matter expert for the department and directly handles routine to complex WC inquiries from staff members.
• Maintains files pursuant to BWC audit rules for self-insured status compliance.
• Assures that all claims are prepared properly for hearing, review all Industrial Commission hearing orders and makes determination on appeals at the administrative level. .
• Collaborates with the DMS nurse case manager on allowance or rejection of requests for treatment, additional allowances or any issue directly affecting a claim through the administrative process.
• Prepares and submits claims, along with all supporting documentation, to the excess insurance carrier. Performs on going claim monitoring and communication with the excess insurer until reimbursement is received.
• Works closely with the Corporate Health department to return employees to transitional duty as promptly as possible, whenever possible.
• Ensures adherence to Occupational Safety and Health Administration (OSHA) claim reporting policies, procedures, and recordkeeping rules.
• Assists Director with projects and other related duties as assigned.

Additional Responsibilities

• Performs other duties as assigned.
• Complies with all policies and standards.
• For specific duties and responsibilities, refer to documentation provided by the department during orientation.
• Must abide by all requirements to safely and securely maintain Protected Health Information (PHI) for our patients. Annual training, the UH Code of Conduct and UH policies and procedures are in place to address appropriate use of PHI in the workplace.