Workers Compensation Specialist Resume Sample
Sherman Mertz
7878 Purdy Key,
Los Angeles,
CA
+1 (555) 483 1540
Work Experience
Workers Compensation Specialist
05/2015
-
PRESENT
Chicago, IL
- Responsible for compliance with all regulations from the Workers’ Compensation Board including timely EDI and compliance reporting requirements and resolution of any EDI and/or compliance issues. Expert knowledge of Disability and Medical Treatment Guidelines. Mentor other case analysts for understanding and compliance to regulations and laws
- Responsible for each case’s compliance with established service standards
- Organize each workload so that all cases receive the proper claims handling and are promptly brought to a conclusion
- Assist in the training, development and orientation of the Case Analysts
- Assist in handling administrative issues that arise in the claims team environment
- Represent the company at meetings and presentations
- Understands and works within PERMA’s Core Beliefs
- Takes a proactive approach to office safety and ergonomics and adheres to all safety policies
- Partners with local Health Services Department to develops and documents plant specific policies and procedures to ensure compliance with mandated programs of Company and Provincial organizations
Workers Compensation Claims Specialist
02/2011
-
03/2015
Dallas, TX
- Collaborates with Third Party Administrator and legal counsel
- Maintain the accuracy and integrity of Workers' Compensation claim records
- Maintain an agency based control and tracking system to enable compliance with OSHA record keeping and annual filing requirements
- Maintain derivative databases that track the incidence of certain types of injury/illness (e.g., carpal tunnel, motor vehicle)
- Generate reports from various records and databases in order to help leadership analyze and determine root causes
- Acts as first and primary point of contact for employees and/or worksite liaisons/supervisors, as appropriate, regarding information needed to process and judge claims; e.g., medical documentation, filing status and exemption form, election to use accrued leave, return- to-work plans
- Responds to employee concerns, such as, completion of paperwork, claim status, payment of medical bills, send forms, as appropriate to provide and work directly with our third party administrator (TPA)
- Communicate with the Director- LP and VP-LP regarding inquiries from attorneys, doctors, and other interested parties, as necessary, regarding claim related matters
Workers Compensation Associate Claims Specialist
05/2004
-
11/2010
San Francisco, CA
- Coordinate a modified work opportunities and requests with the HR Wellness team
- Maintain related communications with the TPA's hearing representative
- Report to management on claim status, costs, causes provided by the Company’s claim provider
- Participate as an advisor or member of safety committees, as requested
- Ensure all Workers Compensation accounts are reviewed timely
- Contact employers and insurance carriers to confirm claim details and obtain billing address
- Communicate carrier information to vendors, to ensure timely delivery of claim to correct party Work collaboratively with Marketing to address any employer billing concerns
- Serve as primary contact for Workers Compensation inquiries
Education
Purdue University North Central
1999 - 2004
Bachelor's Degree in Human Resources
Professional Skills
- Excellent interpersonal, communication, and problem solving skills with excellent attention to detail
- Organizational skills, including the ability to prioritize work and handle multiple tasks simultaneously and under pressure
- Excellent interpersonal and communication skills including the ability to retain a high level of confidentidality
- Strong analytical skills with ability to collect, organize, analyze and disseminate information with attention to detail and accuracy
- Strong project management skills and ability to influence cross functionally
- Excellent understanding of worker’s compensation insurance policy terms and conditions; experience in purchasing and renewing coverage
- Assess complaints and disputes with sound reasoning, decision and problem solving skills, and refer to management to handle
How to write Workers Compensation Specialist Resume
Workers Compensation Specialist role is responsible for training, basic, payroll, compensation, finance, database, purchasing, litigation, shipping, reporting.
To write great resume for workers compensation specialist job, your resume must include:
- Your contact information
- Work experience
- Education
- Skill listing
Contact Information For Workers Compensation Specialist Resume
The section contact information is important in your workers compensation specialist resume. The recruiter has to be able to contact you ASAP if they like to offer you the job. This is why you need to provide your:
- First and last name
- Telephone number
Work Experience in Your Workers Compensation Specialist Resume
The section work experience is an essential part of your workers compensation specialist resume. It’s the one thing the recruiter really cares about and pays the most attention to.
This section, however, is not just a list of your previous workers compensation specialist responsibilities. It's meant to present you as a wholesome candidate by showcasing your relevant accomplishments and should be tailored specifically to the particular workers compensation specialist position you're applying to.
The work experience section should be the detailed summary of your latest 3 or 4 positions.
Representative Workers Compensation Specialist resume experience can include:
- Effectively work with all levels of the organization and cross-functional teams
- Provide direction and management to third party administrators to facilitate resolving all claims quickly and cost effectively
- Communicate effectively with Management, Administrators, Department Managers, Claim Adjusters, etc. regarding claims activity and process
- Prepares and provides information and assistance to attorneys in order to effectively litigate and resolve claims
- Coordinates with applicable parties (vendors, internal payroll, human resource partners) to effectively administer the workers comp process
- Procifiency in MS Office Products and experience with creating and generating reports, plans, instructions, and maintain files
Education on a Workers Compensation Specialist Resume
Make sure to make education a priority on your workers compensation specialist resume. If you’ve been working for a few years and have a few solid positions to show, put your education after your workers compensation specialist experience. For example, if you have a Ph.D in Neuroscience and a Master's in the same sphere, just list your Ph.D. Besides the doctorate, Master’s degrees go next, followed by Bachelor’s and finally, Associate’s degree.
Additional details to include:
- School you graduated from
- Major/ minor
- Year of graduation
- Location of school
These are the four additional pieces of information you should mention when listing your education on your resume.
Professional Skills in Workers Compensation Specialist Resume
When listing skills on your workers compensation specialist resume, remember always to be honest about your level of ability. Include the Skills section after experience.
Present the most important skills in your resume, there's a list of typical workers compensation specialist skills:
- Experience in workers compensation and 3+ years appropriate work experience in human resources, risk management or related field. (5 years total)
- Juris Doctor and 5 or more years of experience in the Claims or Litigation area to include at least 4 years of Workers Compensation Claims experience
- Communicate effectively and tactfully with all levels of management, attorneys and others
- Computer skills to include Microsoft Office / Word / Excel / PowerPoint and ability to learn specialized programs specific to the profession
- Juris Doctor and 5 or more years of experience in the Claims or Litigation area to include at least 3 years of Workers Compensation Claims experience
- Proven ability to solve difficult problems and overcome conflict situations with effective solutions
List of Typical Experience For a Workers Compensation Specialist Resume
1
Experience For Workers Compensation Claims Specialist Resume
- Experience working on Workers Compensation or Liability claims
- Experience working on Workers Compensation claims
- Workers’ compensation claims experience
- Provide additional support in assessing areas to address relative to Safety Training and Loss Control
- Better than basic understanding of OSHA guidelines with emphasis on the regulations relating to worker’s compensation claims
- Serves as a voice in strategic planning aimed at reducing the incidence of worker's compensation-related injuries throughout the organization as a whole
- Basic understanding of reserving, medical management and compensability standards under Maine Workers' Compensation
- Assists employees in understanding their medical conditions and their legal rights and responsibilities
2
Experience For Workers Compensation Senior Claims Specialist Resume
- Collects, evaluates and maintains data concerning workers' compensation
- Work with Holiday’s third-party claims administrator, or TPA, to approve claim reserves and coordinate action plans for resolving claims
- Train Administrators and Department Managers on the internal claim reporting process
- Assist in safety training and provide input on safety issues/concerns
- Facilitate questions regarding benefits and educates employees
- Initiates contact with employees, supervisors, and doctor's office regarding workers' compensation claims
3
Experience For Workers Compensation Associate Claims Specialist Resume
- Engages as a member of the team through participation in meetings and reporting on departmental performance and initiatives
- Maintains filing system on assigned claims
- Practices and procedures of claims management including investigation and evaluation
- California Labor Code, Government Code provisions and case laws governing Workers' Compensation
- Provide assistance with claims and obtaining health care as appropriate
- Provide record keeping support in the Office of Benefits and Leave
4
Experience For Senior Workers Compensation Claims Specialist Resume
- Administer light duty and return to work employee program by closely working with supervisors and department heads
- Communicate with payroll regarding employees status and internal payments
- Self-starter with multitasking abilities
- Track claim costs and overall company costs of claims. Ensures vendors are working in the best interest of the employee and Medline
- Serve as resource for management for all questions related to injuries, post-accident drug testing and return to work options
- Serve as the contact person regarding all work related injuries
5
Experience For Complex Workers Compensation Technical Claims Specialist Resume
- Assist employees with filling out all forms related to a specific injury
- Arrange and follow up on doctor, physical therapy, and diagnostic testing appointments for employees. Maintain appointment log
- Accurately responds to non-routine inquiries from management and employees regarding workers comp in a customer-focused, timely manner
- Coordinate plan of care and provide ongoing communication with patients, adjusters, case managers, insurers and other regulatory agencies
- Have working knowledge of workers’ comp protocols and statutes
6
Experience For Employee Experience Associate Specialist Workers Compensation Resume
- Manage, scan, and input large amounts of incoming documents
- Learn rapidly to develop knowledge and understanding of claims practice
- Oversees workers’ compensation claims, with primary focus on mitigation of the company’s compensation liability
- Provides information and support to employees with work-related medical conditions or disabilities, supervisors, and HR
- Partners with WC Claim team, Legal and HR to facilitate appropriate long term employment solutions for employees permanently impacted under workers’ compensation
7
Experience For Workers Compensation & Leave Program Specialist Resume
- Facilitates and manages the Return to Work program to implement strategies that are cost effective for the company and productive and meaningful for the employee
- Assists in finding Modified Duty assignments
- Tracks employees who are on Modified Duty
- Ensures medical evaluation milestones are met
- Works with the Safety team to support injury prevention programs. Analyzes injury reports to identify trends and provides recommendations and development support of programs or enhancements to reduce incident rates
- Provides oversight of Audiometric testing, ergonomics and Spirometry programs
- Prepares all necessary forms, records and documentation, to include statistical analyses and reports, for all claims assigned, as required by various regulatory agencies including the DWC 1, OSHA 300 log and summary
- Works with Corporate WC Claim team in Mason, OH to provide input and facts regarding claims for cases pending litigation or settlement
- Develops training, policy and procedural revisions
8
Experience For Middle Market Workers Compensation Research Planning & Development Specialist Resume
- Provides analysis and reporting to include metric dashboard presentations, validation of claim data accuracy, incident reporting and analysis, incident investigation, claim management, and business partner support (education/guidance)
- Follows all applicable laws and administers programs in accordance to company policies and procedures
- Investigate and analyze claims information and to draw conclusions
- Administers the Worker's Compensation claims process, receives and reviews all associated documentation and follow-up as needed
- Assist in coordinating all risk management meetings, as well as assist with preparation and distribution of materials needed for presentations. Assist with updating spreadsheets with new loss information, updating open/closed claims, updates dollar amounts, updates number of days of restrictions and updates days away by end of quarter
9
Experience For Workers Compensation Technical Claims Specialist Resume
- Gather data for the preparation of regularly scheduled reports; arrange and compile such reports; and forward those reports to designated personnel in the corporate office
- Oversee slip resistant shoe incentive program
- Oversee TPA claims management, including oversight of TPA adjusters and adherence to special handling instructions, claim handling best practices and Holiday’s culture and philosophy
- Coordinate with Holiday’s Legal Department, Holiday’s TPA and local counsel in litigating denied or disputed claims
- Review and oversee the handling of all workers’ compensation claims for an assigned portfolio of Holiday communities
- Coordinate with other members of Holiday’s risk management team to set strategic goals for managing complex claims
- Implement Holiday’s return-to-work program
10
Experience For Workers Compensation Medical Claims Specialist Resume
- Work with Holiday’s Employee Relations, Safety, Legal and other departments to facilitate a holistic approach to safety and workers compensation losses
- Work with Holiday’s Employee Relations, Safety, Legal and other departments to facilitate a holistic approach to safety and workers’ compensation losses
- Provide support, training and leadership to Holiday communities and field leaders in loss mitigation strategies and the operation of the workers’ compensation program
- Provides oversight regarding WC policy (ies) to include Return to Work policy (ies), and other return to work issues
- Manage key relationship with TPA, law firms, & vendors including contract negotiations, stewardship requirements and proper delivery of services
- Responds to employees’ questions and requests for information relating to coverage matters
- Enjoys collaboration to accomplish goals
- Willing to take ownership and tackle obstacles to meet client's quality standards for service, investigation, reserving, inventory management, teamwork, and diversity appreciation
- Willing to take ownership and tackle obstacles to meet quality standards for service, investigation, reserving, inventory management, teamwork, and diversity appreciation
List of Typical Skills For a Workers Compensation Specialist Resume
1
Skills For Workers Compensation Claims Specialist Resume
- Excellent verbal and written communication skills and ability to interact effectively with all levels within the organization, medical providers and lawyers
- Accurate and current diaries to manage claims effectively and timely
- Above average basic math skills to analyze claims cost, reserves and settlements
- Experience facilitating and managing WC & H&S programs in a manufacturing environment in California
- Demonstrates ability for independent critical thinking, utilizing knowledge and legal guidelines to make appropriate decisions/recommendations
- Experience reviewing claims, determining the nature of claims and adherence to current guidelines, regulations, and policies
- Juris Doctor and 2 or more years of experience in the Claims handling and Litigation area
2
Skills For Workers Compensation Senior Claims Specialist Resume
- Nevada workers compensation claims handling experience
- New York and New Jersey workers compensation claims handling experience
- Experience handling Workers Compensation claims
- Experience handling FL, GA, AL and SC Workers Compensation Claims
- New York and/or New Jersey workers compensation claims handling experience
- PA, VA, DE, DC and/or WV workers compensation claims handling experience
- Texas, Oklahoma, Louisiana, and/or Mississippi workers compensation claims handling experience
- Experience handling Texas, Oklahoma, Louisiana, and Mississippi Workers Compensation Claims
3
Skills For Workers Compensation Associate Claims Specialist Resume
- Arizona claims handling Experience
- California workers’ compensation claims handling experience
- Arizona workers compensation claims handling experience
- Arkansas, Oklahoma & Texas workers compensation claims handling experience
- Strong knowledge of MS programs, including Word and Excel, as well as an ability to quickly learn new software programs
- Initiates appropriate notices as needed; monitors claimant's case history, noting any prior workers' compensation claims filed
- Experience in a manufacturing environment highly desireable
4
Skills For Senior Workers Compensation Claims Specialist Resume
- Establish and maintain effective working relationships with all levels of staff and the public
- Determine validity and compensability of the claim
- Experience handling California Workers’ Compensation Claims
- Experience handling Florida Workers’ Compensation Claims
- California Workers Compensation claims handling experience
- Experience handling Louisiana Workers Compensation Claims
- Workers’ compensation claims handling experience
- GA, FL , AL, NC and/or SC workers’ compensation claims handling experience
5
Skills For Complex Workers Compensation Technical Claims Specialist Resume
- CA workers compensation claims handling experience
- Experience handling construction industry workers compensation claims
- Experience handling Minnesota and West Virginia Workers Compensation claims
- Workers compensation claims handling experience
- GA, FL, AL, NC and/or SC workers’ compensation claims handling experience
- Excellent claims management documentation within the TPA claims software system (ACTS) to ensure compliance with audit standards and requirements
- Senior level knowledge and eight (8) years’ experience in human resources practices and principles
- Claims experience in workers compensation
6
Skills For Employee Experience Associate Specialist Workers Compensation Resume
- Workers compensation experience preferably in the Entertainment field
- Juris Doctor and 2 or more years of experience in the Claims and Litigation area
- Juris Doctor and 5 or more years of experience in the Claims or Litigation area OR
- NY, NJ, PA, VA, DE and/or DC workers compensation claims handling experience
- One year of workers compensation experience
- Experience with Workers Compensation
- Excel, Microsoft and Outlook experience
- ADR (Alternate Dispute Resolution) Experience
- Highly skilled in MS Word, Excel and Power Point
7
Skills For Workers Compensation & Leave Program Specialist Resume
- Experience in risk management desired
- Demonstrated ability to treat confidential matters with appropriate discretion
- Facilitates changes or enhancements to improve the overall effectiveness of the Worker Compensation program
- Solid familiarity through practice and/or education with state and federal regulations in the areas of Leaves of Absence/FMLA, ADA and interactive process
- Experience working with Workers’ Compensation claims
- Experienced with Workers’ Compensation programs
- Experience in a large company
- Kronos (HRIS System) experience is desired
8
Skills For Middle Market Workers Compensation Research Planning & Development Specialist Resume
- Is responsible for completing, updating and reporting OSHA logs for all facilities to BLS and OSHA
- Complete pre-employment, post accident, and random drug testing and breath alcohol testing for employees including those covered by DOT regulations
- Maintain ordering and shipping of drug testing supplies for all locations
- Act as a liaison between all parties in workers compensation claims to ensure quality claims management including providing updates and recommendations
- Prepare forms related to workers' compensation claim reporting in multiple states. Ensure organization and timely filing of all documents
- Act as subject matter expert for management at business units, coaching and guiding them through the claims process
- Oversee and monitor the claim process from beginning to end to ensure proper and timely closing
9
Skills For Workers Compensation Technical Claims Specialist Resume
- Gathers facts regarding claims for cases pending litigation
- Complete pre-employment, post-accident, and random drug testing and breath alcohol testing
- Provide reserve and settlement authority according to department procedures
- Act as the first level of appeal for Dart personnel regarding claim decisions
- Establish reserves and authorize payments within reserving authority limits
10
Skills For Workers Compensation Medical Claims Specialist Resume
- Comply with all safety rules and regulations during work hours in conjunction with the Injury and Illness Prevention Program (IIPP)
- Possesses basic knowledge of legal reporting requirements per the Maine Workers Compensation Laws
- CPR Certified and Blood-Borne Pathogen Training
- A self-starter with a positive approach to getting the job done in a timely manner
- Proficient in managing insurance brokerage relationships
- Background in WSIB claims handling and management
- Background in Workers Compensation claims handling and management
- Review and respond to all emails filtered through DL, relating to Workers Compensation
List of Typical Responsibilities For a Workers Compensation Specialist Resume
1
Responsibilities For Workers Compensation Claims Specialist Resume
- Experienced in standard established risk management practices
- Coordinates and administers activities associated with determining primary liability and negotiating resolution of workers' compensation claims
- Coordinates claims handling, data analysis, and maintains the program within state regulations and supports Allina Health Risk Services with goals, processes, and strategic initiatives related to workers’ compensation
- Assists in the monitoring, evaluation and coordination of ongoing medical treatment for the injured employees
- Coordinates analysis of employee incident reports, identifying trends, commonalities and patterns so that reason of reoccurrence can be ascertained in order to correct the circumstances, thus reducing injuries
2
Responsibilities For Workers Compensation Senior Claims Specialist Resume
- Accurate reserve analysis following reserve best practices including the completion of a reserve worksheet with documentation on the claim file
- Build rapport, establish an interactive process and foster a caring culture with employees
- Determine need to report claims to TPA for handling
- Communicate directly with employees in a professional and courteous manner while explaining the claim process
- Distribution of weekly and monthly claim/metric reports to Management providing claim statistics and results
3
Responsibilities For Workers Compensation Associate Claims Specialist Resume
- Ensure appropriate medical care is provided for those that require it, as well as monitor vendors to make sure they are actively managing Medline's claims
- Coordinate between patient, doctor???s offices, and insurance carriers to resolve billing issues
- Serve as the main point of contact regarding all work related injuries
- Arrange and follow up on doctor, physical therapy and diagnostic testing appointments for employees
- Communicate with insurance carrier for claims processing
- Ensures proper implementation of Workers Compensation/Occupational Benefits claims handling and oversees Third Party Administrator processes
- Works with third party administrator to assist with the coordination of treatment, follow-up and referral of all work related injuries and illnesses
4
Responsibilities For Senior Workers Compensation Claims Specialist Resume
- Drive claims process via proactive and regular dialogues with adjusters to ensure timely follow through of actions items
- Lead claim review meetings
- Collaborate with Disability Case Managers to identify employees’ work restrictions and analyze potential accommodations
- Advise and consult with human resources and employees’ managers on claim resolution
- Participate on the various committees and advise on workers’ compensation related issues
- Processes day to day requests for insurance issues such as certificates of insurance, verification of coverage documents,
- Works with attorneys and Director of insurance on advice matters and claim issue
- Coordinates and oversees assigned workers’ compensation claims with adjusters, case managers, providers, claimants, supervisors to ensure claims are being properly adjusted. Communicates regularly with principals/supervisors and HR regarding active claims while injured worker is losing time due to injury
- Identifies transitional duty candidates from the information received on return-to-work status reports (DWC-73) from the injured employees’ treating physician. Coordinates back-to-work transition, adhering to employee’s restrictions, by providing a Bona Fide Job Offer to the injured employee, per HISD Policy CRE2
5
Responsibilities For Complex Workers Compensation Technical Claims Specialist Resume
- Review and manage all incident reports for employee incidents from initial report through conclusion/closure of claim
- Manage claims database and TPA's claim information, via internal software as well as via various TPA databases
- Manage external attorneys on litigated matters
- Maintenance of internal claim files
- Participate actively in various risk management meetings
- Develop Webinars on claims process as well as safety topics
- Review and manage internal safety inspection checklist/process (monthly/quarterly)
- Keep safety manual up to date and provide input for improvements
6
Responsibilities For Employee Experience Associate Specialist Workers Compensation Resume
- Overall ownership of global workers compensation for both insured and self-insured models
- Design and implement the process and workflows that are efficient and aligned with our culture
- Act as the Liaison between the employee and the Third Party Administrator
- Verifies wages, work injuries and work restrictions
- Coordinates with all productions to ensure the proper state forms are completed and procedures are followed
- Establishes and maintains case files, logs, and indexes; reviews documentation and records
- Verifies job-related accidents with claimants and supervisors
7
Responsibilities For Workers Compensation & Leave Program Specialist Resume
- Addresses suspicious claims and delays cases when necessary
- Maintains and updates diaries on employee's workers' compensation injury status
- Authorizes any and all medically necessary treatment; authorizes payments
- Monitors payments for permanent disability
- Understand, interpret and follow laws, ordinances, regulations and procedures
8
Responsibilities For Middle Market Workers Compensation Research Planning & Development Specialist Resume
- Knowledge of basic medical terminology related to the cause and treatment of occupational injuries and diseases
- Manage a caseload and respond to requests in a timely manner
- Possession of a certificate in Workers' Compensation from an institution recognized by the California Department of Insurance or the Insurance Education Association is highly desired
- Receive and process accident reports and workers’ compensation claims
- Serve as a liaison between the employee, department, and adjusters
9
Responsibilities For Workers Compensation Technical Claims Specialist Resume
- File all insurance forms and Texas Department of Workers’ Compensation reports
- Handle wage statements, first report of injury, supplement report, and job information in a timely manner
- Establish and maintain contact with injured employees
- Communicate with workers’ compensation insurance carrier, doctors, nurses, departments, and health care providers to enable appropriate processing of claims
- Work closely with department secretaries, supervisors, and administrators to facilitate reporting work-related illnesses and injuries
- Work with leave and benefit specialists to ensure appropriate use and access to applicable leave and insurance benefits
10
Responsibilities For Workers Compensation Medical Claims Specialist Resume
- Report and educate campus staff on workers comp
- Regularly communicate with HR staff, other department staff, employees, and the public
- Regularly interacts, interviews and partners with employees to complete accident investigation and root cause analysis
- Process the claim to insurance company and to individual state based on additional requirements
- Accurately maintains all workers comp documents, both accident and incident investigations
- Communicates and interacts with employees, insurance adjusters, medical professionals, and legal advisors
- Serves as the representative of the company represents and attends Workers' Compensation Administration mediation and formal hearings and partners with appropriate level of authority internally to settle claims
- Assist with Production meetings and trainings
- CWCP certification is desired
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