Claims Specialist
Orem, UT
Investments – Risk Management /
Full-Time /
Hybrid
The Claims Specialist is responsible for monitoring insurance claims, some governmental complaints and legal items not covered by insurance. This role involves liaising with employees, managers, insurance representatives, medical staff, and attorneys to effectively communicate case status updates and relevant information, including notifications of hearings, outcomes, and return-to-work statuses or restrictions. The Specialist follows through on insurance claims, coordinates repairs related to these claims, and manages the receipt of insurance funds.
In addition, the Claims Specialist conducts thorough investigations of incidents, evaluates safety risks, and collaborates with various teams and departments to implement corrective actions aimed at preventing future occurrences. Regular reviews of overall cases are conducted to identify trends, and the Specialist maintains up-to-date knowledge of all regulations and laws related to workers' compensation claims reporting.
This position oversees the workers' compensation program for Havenpark Communities in the four monopolistic states and for all other states, ensuring a consistent process for recording, investigating, and reporting claims in compliance with applicable laws and regulations. The role also includes preparing and submitting required reports and documentation to OSHA, state, and local agencies, as well as other entities. The Claims Specialist may coordinate or assist with safety programs focused on injury prevention and facilitate accommodations for workers, ensuring a proactive approach to risk management.
Additionally, the Claims Specialist provides support and backup for the placement and maintenance of insurance programs, working closely with the Director of Risk Management, brokers, and stakeholders to maintain optimal coverage.
Responsibilities
- Incident Reporting (~30% of time)
- Manages daily incident reporting, conducting thorough investigations to assess root causes and safety risks.
- Coordinates with various teams and departments to evaluate incidents, implement corrective actions, and prevent future occurrences.
- Claims Management 40% (~40% of time)
- Monitors all claims and legal items not covered by insurance, ensuring thorough communication with employees, managers, insurance representatives, medical staff, and attorneys.
- Communicates case status details and pertinent information, including notifications of hearings, outcomes, return-to-work status, or restrictions.
- Manages claims to ensure they are processed efficiently, collecting insurance checks as they are received and ensuring proper application of funds.
- Explores solutions for non-traditional methods of funds recovery, including subrogation.
- Conducts thorough investigations of incidents, evaluates safety risks, and coordinates with various teams and departments to implement corrective actions and prevent future occurrences.
- Performs periodic reviews of overall cases to identify trends, maintaining up-to-date knowledge of all regulations and laws related to reporting claims.
- Workers Compensation (~15% of time)
- Administers the workers' compensation program for Havenpark Communities, specifically addressing requirements in the four monopolistic states as well as policies for other states.
- Addresses employee situations with care and urgency, ensuring prompt assistance and support.
- Follows up with appropriate agencies and medical providers to facilitate effective claims processing and communication.
- Provides clear documentation on incidents and ensures compliance with all reporting requirements related to employee injuries and claims.
- Liaises with medical providers and regulatory agencies to facilitate effective claims processing and communication.
- Risk Management (~10% of time)
- Ensures that community practices are both safe and efficient
- Maintains up to date knowledge of safety regulations and laws
- Coordinates with the director of risk management to develop safety programs
- Legal Reporting (~5% of time)
- Submits accurate reports to government agencies, regarding items such as motor vehicle insurance and workers compensation, OSHA 300 logs
Qualifications
- Education: Bachelors Degree in related field preferred
- Experience: 2-4 years of related experience
- Physical Demands: Spend long hours sitting while using office equipment, such as computers.
- Skills: Team player with excellent verbal and written communication skills; self-motivated, organized, and strong problem-solving abilities.
- Ability to handle difficult situations in a professional manner.
- Proficient in handling confidential and sensitive information, ensuring compliance with Fair Housing, HIPAA, and other regulations.
