Henry Ford Health
Sr. Claims Consultant - Work Compliance | Full Time | Detroit, MI (Hybrid)
Henry Ford Health, Detroit, Michigan, United States, 48228
Provide key system role in workers compensation and employers liability claims review, investigation, management and disposition, including financial mitigation of indemnity payment and claim defense costs and management of System reputation. Will work under the guidance of Senior Claims Managers, Director of Insurance, and Vice President, to learn and develop the skills necessary for more independent work and decision making.
PRINCIPLE DUTIES AND RESPONSIBILITIES:
Conducts internal investigation, negotiation, and resolution of asserted workers compensation and employer’s liability claims.
Oversees and coordinates internal/external investigation and resolution of claims, and lawsuits and acts as a system representative of HFHS in cases before the courts, pretrial/settlement conferences, workers compensation bureau and trials.
Reviews and analyzes facts, medical records, and medical opinions. Prepare statistical, financial, and factual reports for audit and actuarial studies. Provide status reports to department Chairperson/HFH Leadership on claims exposure.
Tracks case files and claims information which may typify trends or causal relationships for risk management analysis, provides periodic in-service education, presents cases to internal review committees, and communicates progress/activity with supervisor with emphasis of trends and quality improvement. Inputs case information and updates information in Risk Finance and Insurance Services database.
Builds and maintains positive partnership with all office personnel.
Develop liaison relationships with System Risk Managers, Department and Division Heads, Medical Directors, treaters and system employees and managers while assisting them in crisis management, risk reduction and/or mitigation and other general related risk issues.
Control and manage vendor payments.
Examine defense firm billings and submit for payment.
Complete and file all required forms with workers compensation bureau.
Manage internal/external provider billings.
Provides support to all HFHS staff regarding receipt of subpoenas.
Liaison among witnesses, attorneys and law enforcement who issue subpoenas.
Provide advice to physicians/other staff on process of being served.
EDUCATION/EXPERIENCE REQUIRED:
Bachelor's degree in Business Administration, Human Resources, Risk Management, or a related field.
Minimum of 5 years of experience in workers' compensation management, risk management, or related field. Experience in consulting or advisory roles a plus.
Strong understanding of workers' compensation laws, regulations, and best practices.
Strong analytical, problem solving, and decision-making skills.
Excellent communication and people skills.
Proven history of successfully leading complex clinical application projects.
Ability to work collaboratively with cross-functional teams and external partners.
In-depth knowledge of regulatory requirements and industry standards for clinical applications.
Additional Details
This posting represents the major duties, responsibilities, and authorities of this job, and is not intended to be a complete list of all tasks and functions. It should be understood, therefore, that incumbents may be asked to perform job-related duties beyond those explicitly described above.
Overview
Partnering with nearly 2 million people on their health journey, Henry Ford Health provides a full continuum of services at 250 care locations throughout southeast and south central Michigan. With 33,000 valued team members, Henry Ford is also among Michigan’s largest and most diverse employers. Our superior care and discoveries are powered by nearly 6,000 physicians, researchers and advanced practice providers. Learn more at henryford.com.
Benefits
Whether it's offering a new medical option, helping you make healthier lifestyle choices or making the employee enrollment selection experience easier, it's all about choice. Henry Ford Health has a new approach for its employee benefits program - My Choice Rewards. My Choice Rewards is a program as diverse as the people it serves. There are dozens of options for all of our employees including compensation, benefits, work/life balance and learning - options that enhance your career and add value to your personal life. As an employee you are provided access to Retirement Programs, an Employee Assistance Program (Henry Ford Enhanced), Tuition Reimbursement, Paid Time Off, Employee Health and Wellness, and a whole host of other benefits and services. Employee's classified as contingent status are not eligible for benefits.
Equal Employment Opportunity/Affirmative Action Employer
Equal Employment Opportunity / Affirmative Action Employer Henry Ford Health is committed to the hiring, advancement and fair treatment of all individuals without regard to race, color, creed, religion, age, sex, national origin, disability, veteran status, size, height, weight, marital status, family status, gender identity, sexual orientation, and genetic information, or any other protected status in accordance with applicable federal and state laws.
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PRINCIPLE DUTIES AND RESPONSIBILITIES:
Conducts internal investigation, negotiation, and resolution of asserted workers compensation and employer’s liability claims.
Oversees and coordinates internal/external investigation and resolution of claims, and lawsuits and acts as a system representative of HFHS in cases before the courts, pretrial/settlement conferences, workers compensation bureau and trials.
Reviews and analyzes facts, medical records, and medical opinions. Prepare statistical, financial, and factual reports for audit and actuarial studies. Provide status reports to department Chairperson/HFH Leadership on claims exposure.
Tracks case files and claims information which may typify trends or causal relationships for risk management analysis, provides periodic in-service education, presents cases to internal review committees, and communicates progress/activity with supervisor with emphasis of trends and quality improvement. Inputs case information and updates information in Risk Finance and Insurance Services database.
Builds and maintains positive partnership with all office personnel.
Develop liaison relationships with System Risk Managers, Department and Division Heads, Medical Directors, treaters and system employees and managers while assisting them in crisis management, risk reduction and/or mitigation and other general related risk issues.
Control and manage vendor payments.
Examine defense firm billings and submit for payment.
Complete and file all required forms with workers compensation bureau.
Manage internal/external provider billings.
Provides support to all HFHS staff regarding receipt of subpoenas.
Liaison among witnesses, attorneys and law enforcement who issue subpoenas.
Provide advice to physicians/other staff on process of being served.
EDUCATION/EXPERIENCE REQUIRED:
Bachelor's degree in Business Administration, Human Resources, Risk Management, or a related field.
Minimum of 5 years of experience in workers' compensation management, risk management, or related field. Experience in consulting or advisory roles a plus.
Strong understanding of workers' compensation laws, regulations, and best practices.
Strong analytical, problem solving, and decision-making skills.
Excellent communication and people skills.
Proven history of successfully leading complex clinical application projects.
Ability to work collaboratively with cross-functional teams and external partners.
In-depth knowledge of regulatory requirements and industry standards for clinical applications.
Additional Details
This posting represents the major duties, responsibilities, and authorities of this job, and is not intended to be a complete list of all tasks and functions. It should be understood, therefore, that incumbents may be asked to perform job-related duties beyond those explicitly described above.
Overview
Partnering with nearly 2 million people on their health journey, Henry Ford Health provides a full continuum of services at 250 care locations throughout southeast and south central Michigan. With 33,000 valued team members, Henry Ford is also among Michigan’s largest and most diverse employers. Our superior care and discoveries are powered by nearly 6,000 physicians, researchers and advanced practice providers. Learn more at henryford.com.
Benefits
Whether it's offering a new medical option, helping you make healthier lifestyle choices or making the employee enrollment selection experience easier, it's all about choice. Henry Ford Health has a new approach for its employee benefits program - My Choice Rewards. My Choice Rewards is a program as diverse as the people it serves. There are dozens of options for all of our employees including compensation, benefits, work/life balance and learning - options that enhance your career and add value to your personal life. As an employee you are provided access to Retirement Programs, an Employee Assistance Program (Henry Ford Enhanced), Tuition Reimbursement, Paid Time Off, Employee Health and Wellness, and a whole host of other benefits and services. Employee's classified as contingent status are not eligible for benefits.
Equal Employment Opportunity/Affirmative Action Employer
Equal Employment Opportunity / Affirmative Action Employer Henry Ford Health is committed to the hiring, advancement and fair treatment of all individuals without regard to race, color, creed, religion, age, sex, national origin, disability, veteran status, size, height, weight, marital status, family status, gender identity, sexual orientation, and genetic information, or any other protected status in accordance with applicable federal and state laws.
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