Human Resources - Workers' Compensation Specialist
il y a 10 jours
Hauppauge
Job Description The Human Resources - Workers’ Compensation Specialist oversees the full lifecycle of workers’ compensation claims, ensuring timely, accurate, and cost-effective resolution. This role serves as the primary liaison between the organization, Third-Party Administrators (TPAs), insurance carriers, and internal stakeholders to monitor claim progress, manage costs, and ensure compliance with all regulatory requirements. In addition, this position plays a critical employee-facing role by providing outreach, guidance, and support to injured team members. The Specialist ensures appropriate medical care, clear communication, and a safe, timely return-to-work whenever possible. Using data, analytics, and proactive claim management strategies, this role helps reduce financial exposure while supporting employee well-being. Essential Functions, Responsibilities, and Duties Claims Management & Administration • Serve as the primary point of contact for all workers’ compensation claims with the Third-Party Administrator (TPA)., • Manage the complete claim lifecycle, from incident reporting through claim closure., • Ensure timely, accurate submission of all required documentation and reports., • Monitor claim activity, including medical treatment, indemnity payments, reserves, and return-to-work status., • Actively manage claim reserves, settlements, and overall claim strategy to minimize financial exposure., • Review and challenge inappropriate charges, treatment plans, or reserve levels in coordination with the TPA., • Identify and promote early return-to-work opportunities, including light duty or modified assignments., • Contact injured employees promptly following claim submission to express concern, explain the process, and confirm appropriate care., • Maintain ongoing communication throughout the claim to support recovery and employee engagement., • Serve as a trusted resource for questions related to benefits, medical treatment, and return-to-work expectations., • Track and report key claim metrics, including new, open, and closed claims; reserves; medical and indemnity costs; and trends., • Prepare dashboards and regular reports for HR, Safety, Finance, and executive leadership., • Analyze claims data to identify patterns, risk drivers, and opportunities for loss prevention., • Partner with Safety, HR, and Operations to improve injury prevention efforts, reporting accuracy, and claim outcomes., • Participate in incident reviews and root-cause analyses to reduce future claims., • Support training and awareness initiatives related to injury reporting and workers’ compensation procedures., • Support evolving business needs by taking on special projects and interim responsibilities as assigned., • Assist with insurance renewals, audits, and claims reviews., • Participate in system upgrades or reporting enhancements related to workers’ compensation and risk management., • Perform other related duties as assigned.