Worker's Compensation Specialist

POSITION PURPOSE

The Workers Compensation Specialist is responsible for the comprehensive management of workers compensation claims from inception to resolution for The Raley's Companies. The Specialist will analyze claims trends, implement best practices, and oversee strategies to reduce lost time and medical cost. Incumbents in this job classification must possess strong analytical skills and experience, have a proactive approach to process improvement, and the ability to collaborate effectively with internal and external stakeholders to achieve optimal claim outcomes. The role needs comprehensive knowledge of computer applications, particularly risk management information systems and knowledge of Risk Management practices and business requirements. Bilingual language fluency in English and Spanish.

ESSENTIAL JOB FUNCTIONS AND BASIC DUTIES

1. *Claims management

a. Monitor third party administrators (TPA) management of workers compensation claims, ensuring timely processing, compliance with contracted service delivery, and compliance with state and federal regulations.

b. Assist in investigating claims by gathering necessary information from employees, supervisors, and medical providers.

c. Monitors claim status, medical treatment plans and team members return to work status.

d. Identifies and tracks critical diary dates and ensures TPA is providing regular file reviews to facilitate claims toward closure.

2. *Communication and documentation

a. Acts as the primary contact for all workers compensation claims, maintaining clear and effective communication with all stakeholders, including employees, supervisors, medical providers and TPA adjusters.

b. Provides regular updates to all parties involved regarding claim processing/closure status, treatment progress and any other relevant information, as appropriate.

c. Records case status in RMIS and in other systems (Origami/Riskonnect) to capture claim status and case history.

3. *Case settlement and reserves

a. Approves case reserves and authorized to settle claims within authority.

b. Evaluates claims for settlement opportunities and negotiates settlements in the best interest of the Company and the injured worker.

4. *Compliance reporting

a. Prepares and submits required reports to regulatory agencies and insurance carriers in a timely manner.

b. Coordinates and assists with the filing of all OSHA 300 and 300A annual reports.

c. Reports 8- and 24-hour reportable injuries to OSHA.

d. Ensures all claims are managed in compliance with relevant laws, regulations, and company policies.

5. *Data analysis, reporting and recommendations.

a. Provides periodic reporting to the Finance Department.

b. Monitors and analyzes trends in workers compensation claims to identify potential issues and areas of improvement. Presents findings and recommendations to corporate and store leaders in individual and group settings.

c. Collaborates with safety teams to identify trends in workplace near-miss and injuries and assists with strategies for injury prevention.

d. Provides insights and recommendations to improve the workers compensation program, RMIS, and stakeholder partnership.

MINIMUM QUALIFICATIONS

EDUCATION AND EXPERIENCE: Associates degree in business or communications degree field with a minimum of two or more (2+) of office work experience. Prior experience of 2 years or more with workers compensation claims investigation and reporting and ongoing contact with workers compensation carrier and third-party administrator.

REQUIRED

KNOWLEDGE: Strong knowledge of English and Spanish grammar, spelling, and punctuation. Strong knowledge of workers compensation laws and regulations. Basic knowledge of office procedures. Knowledge of industry practices, federal state and local laws and regulations related to workers compensation and safety. Knowledge of standard office software applications. Spanish language fluency proficiency to speak and write.

SKILLS/ABILITIES: Ability to maintain confidentiality. Handles multiple tasks simultaneously, prioritize effectively, and meets designated deadlines. Strong self-directing and initiating skills to be able to identify trends, opportunities and process improvements. Ability to be flexible in changing work priorities. Ability to escalate difficult matters, as necessary. Ability to provide functional project leadership. Proficient communication and negotiation skills. Proficient using claims management software and Microsoft Office Suite. Strong organizational, analytical, and problem-solving skills Ability to read, write, perform basic arithmetic, and follow verbal and written instructions. Maintains effective communication and working relationships with all levels of the organization and business contacts.