Cayuga Health System
Workers Compensation Specialist
Cayuga Health System, Ithaca, New York, us, 14851
Workers Compensation Specialist
Cayuga Health and its affiliates are the region's leading healthcare system and most trusted providers of integrated health services, empowering our people in our mission to equitably improve the well-being of the communities we serve. Our commitment to providing extraordinary healthcare begins with our team of extraordinary professionals who are continuously discovering clinical innovations and enhancing access to the most up-to-date facilities, equipment, technologies, and research protocols. Cayuga Health's commitment to our employees includes competitive compensation, comprehensive employee benefits programs, and the opportunity to explore and build a career in healthcare through our many professional development programs.
The Workers Compensation Specialist at Cayuga Health System is responsible for the day-to-day activities of administering the Workers Compensation program including timely filing of claims, monitoring open claims, coordinating prompt return to work, and effectively communicating with employees, supervisors, medical providers, and the insurance adjuster. The Specialist will ensure timely and appropriate collaboration with the Human Resources benefits team to ensure that transitions (i.e. - return to work, re-allocation of modified duty employees, etc.) are optimized. The ideal candidate will have experience planning and organizing activities related to workers compensation programs. The position reports to the AVP, Chief Risk & Quality Officer with a dotted line to the Benefits team.
The role involves active management and tracking of loss control measures put in place to reduce likelihood of recurrence or exposure as indicated by the organization's loss experience and market trends. The ideal candidate will have a general understanding of the insurance industry and is comfortable learning and completing activities that evolve the organization's workers compensation insurance lines.
Roles and Responsibilities:Claims Management : Conducts investigations of claims to confirm coverage and to determine liability, compensability, and damages. Works closely with claimants, witnesses and members of the medical profession and other persons pertinent to the investigation and processing of claims. Identifies wage loss expenses and wage exposures on medical claims.
Documents receipt and contents of medical reports. Interacts frequently with claimant to understand nature and extent of injury and medical conditions. Reviews and handles other correspondence within authority including material from the team members, and/or clients.
Insurance & Regulatory : Verifies policy coverage for submitted claims and notifies the insured of any issues; determines and establishes reserve requirements, adjusting reserves, as necessary, during the processing of the claim.
Review, develop and implementation of policies, assisting in the activities that define a workers safety program and OSHA reporting responsibilities.
Resource Management : Keeps Team Manager informed verbally and in writing of activities and problems within assigned area of responsibility; refers matters beyond limits of authority and expertise to Team Manager for direction.Authority:
Adheres to client and carrier guidelines and prepares written updates for supervisor to review.
Approves payments of medical bills on lost time disability claims within area of payment authority up to, but not exceeding, $2,500 after compensability has been determined.With the team managers guidance, provides input on the completion of status reports, initiates activity checks and/or widow's statement of dependency forms.
Risk Management : Evaluates medical claims for potential fraud issues, loss control and recovery in accordance with insurance policy contracts, medical bill coding rules and state regulations.Quality Assurance : Ensure that deliverables meet optimal quality standards and aims to improve the experience of our employees and valued partners.Customer Service:
Respond to employees' questions regarding benefits, coverage, workers compensation, return to work, safety protocols, and coordinates with appropriate stakeholders to ensure closed loop communication where necessary.Competency and Education:
Works closely with third party administrators (TPA) and vendors to ensure
Required Skills and Experience:
Bachelor's degree in human resources, finance, business administration, or a related field. Education and experience may be considered interchangeable on a year-for-year basis.A minimum of two years of work experience in insurance, human resources, leave administration, or a related field.High level of interpersonal skills and the ability to build and maintain positions relationships both internally and externally.Exceptional analytical skillsWorks well independently, works collaboratively within HR team, and cross-functional teamsSafeguard sensitive information and maintain high level of confidentialityExcellent oral, written, and phone communication skillsProficient in MS office applications including Word, Excel, and OutlookStrong bias for action and keen sense of urgency with limited guidanceExcellent problem solving, critical thinking, and decision making skillsPreferred Skills and Experience:
While not required, certification through a Workers Compensation Program is desirable or must be obtained within 2 years of hire.Physical Requirements:
Sedentary work: Exerting up to 10 pounds of force occasionally in carrying, lifting, pushing, pulling objects. Sitting most of the time, with walking and standing required only occasionally.Location and Travel Requirements:
Hybrid / Onsite at CMC Main CampusHybrid-Remote/In-Person (Predominantly remote)Travel: Required within the various CHS locations.Pay Range Disclosure:
$58,458 to $75,000 per year
Cayuga Health System and its affiliates are committed to treating all patients, providers, staff and volunteers equitably and with dignity, ensuring the highest levels of safety, care and respect, and striving to recognize and overcome biases and policies that contribute to disparities in healthcare access, equitable care and positive health outcomes for all.
We are proud to be an Equal Employment Opportunity employer, supporting the growth and health of our employees and community by embracing the rich diversity, needs and circumstances of all peoples and prioritizing opportunities to build a diverse and inclusive workplace. We do not discriminate based upon race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity, gender expression, age, status as a protected veteran, status as an individual with a disability, or other applicable protected characteristics.
If you require reasonable accommodation to complete a job application, pre-employment testing, a job interview or to otherwise participate in the hiring process, please contact the Cayuga Health Talent Acquisition team at .
I certify that the information contained in this application is correct and complete to the best of my knowledge. I understand that any falsification or omission of information may disqualify me from further consideration for employment or, if hired, may result in termination. In consideration for my employment, I agree to abide by the rules and regulations of the company, which rules may be changed, withdrawn, added, or interpreted at any time, at the company's sole option and without prior notice to me.
I understand that any hiring decision is contingent upon my successful completion of all of the Company's lawful pre-employment/post-offer checks, which may include a background check, drug screen, employment references, and licensing review. If I am made a conditional offer of employment, I agree to execute any consent forms necessary for the Company to conduct its lawful pre-employment/post-offer checks. Such checks will not be conducted until allowed under applicable federal, state, and local law. I understand if I have a criminal background, it will not automatically disqualify me from employment unless otherwise required by law. I agree to execute any consent forms necessary for the Company to conduct its lawful pre-employment checks.
I also understand that the Company is a drug and alcohol-free workplace and has a drug and alcohol testing program consistent with applicable federal, state, and local law. I understand that after a conditional offer of employment, I must submit to and pass a pre-employment drug test as a condition of employment.
Cayuga Health and its affiliates are the region's leading healthcare system and most trusted providers of integrated health services, empowering our people in our mission to equitably improve the well-being of the communities we serve. Our commitment to providing extraordinary healthcare begins with our team of extraordinary professionals who are continuously discovering clinical innovations and enhancing access to the most up-to-date facilities, equipment, technologies, and research protocols. Cayuga Health's commitment to our employees includes competitive compensation, comprehensive employee benefits programs, and the opportunity to explore and build a career in healthcare through our many professional development programs.
The Workers Compensation Specialist at Cayuga Health System is responsible for the day-to-day activities of administering the Workers Compensation program including timely filing of claims, monitoring open claims, coordinating prompt return to work, and effectively communicating with employees, supervisors, medical providers, and the insurance adjuster. The Specialist will ensure timely and appropriate collaboration with the Human Resources benefits team to ensure that transitions (i.e. - return to work, re-allocation of modified duty employees, etc.) are optimized. The ideal candidate will have experience planning and organizing activities related to workers compensation programs. The position reports to the AVP, Chief Risk & Quality Officer with a dotted line to the Benefits team.
The role involves active management and tracking of loss control measures put in place to reduce likelihood of recurrence or exposure as indicated by the organization's loss experience and market trends. The ideal candidate will have a general understanding of the insurance industry and is comfortable learning and completing activities that evolve the organization's workers compensation insurance lines.
Roles and Responsibilities:Claims Management : Conducts investigations of claims to confirm coverage and to determine liability, compensability, and damages. Works closely with claimants, witnesses and members of the medical profession and other persons pertinent to the investigation and processing of claims. Identifies wage loss expenses and wage exposures on medical claims.
Documents receipt and contents of medical reports. Interacts frequently with claimant to understand nature and extent of injury and medical conditions. Reviews and handles other correspondence within authority including material from the team members, and/or clients.
Insurance & Regulatory : Verifies policy coverage for submitted claims and notifies the insured of any issues; determines and establishes reserve requirements, adjusting reserves, as necessary, during the processing of the claim.
Review, develop and implementation of policies, assisting in the activities that define a workers safety program and OSHA reporting responsibilities.
Resource Management : Keeps Team Manager informed verbally and in writing of activities and problems within assigned area of responsibility; refers matters beyond limits of authority and expertise to Team Manager for direction.Authority:
Adheres to client and carrier guidelines and prepares written updates for supervisor to review.
Approves payments of medical bills on lost time disability claims within area of payment authority up to, but not exceeding, $2,500 after compensability has been determined.With the team managers guidance, provides input on the completion of status reports, initiates activity checks and/or widow's statement of dependency forms.
Risk Management : Evaluates medical claims for potential fraud issues, loss control and recovery in accordance with insurance policy contracts, medical bill coding rules and state regulations.Quality Assurance : Ensure that deliverables meet optimal quality standards and aims to improve the experience of our employees and valued partners.Customer Service:
Respond to employees' questions regarding benefits, coverage, workers compensation, return to work, safety protocols, and coordinates with appropriate stakeholders to ensure closed loop communication where necessary.Competency and Education:
Works closely with third party administrators (TPA) and vendors to ensure
Required Skills and Experience:
Bachelor's degree in human resources, finance, business administration, or a related field. Education and experience may be considered interchangeable on a year-for-year basis.A minimum of two years of work experience in insurance, human resources, leave administration, or a related field.High level of interpersonal skills and the ability to build and maintain positions relationships both internally and externally.Exceptional analytical skillsWorks well independently, works collaboratively within HR team, and cross-functional teamsSafeguard sensitive information and maintain high level of confidentialityExcellent oral, written, and phone communication skillsProficient in MS office applications including Word, Excel, and OutlookStrong bias for action and keen sense of urgency with limited guidanceExcellent problem solving, critical thinking, and decision making skillsPreferred Skills and Experience:
While not required, certification through a Workers Compensation Program is desirable or must be obtained within 2 years of hire.Physical Requirements:
Sedentary work: Exerting up to 10 pounds of force occasionally in carrying, lifting, pushing, pulling objects. Sitting most of the time, with walking and standing required only occasionally.Location and Travel Requirements:
Hybrid / Onsite at CMC Main CampusHybrid-Remote/In-Person (Predominantly remote)Travel: Required within the various CHS locations.Pay Range Disclosure:
$58,458 to $75,000 per year
Cayuga Health System and its affiliates are committed to treating all patients, providers, staff and volunteers equitably and with dignity, ensuring the highest levels of safety, care and respect, and striving to recognize and overcome biases and policies that contribute to disparities in healthcare access, equitable care and positive health outcomes for all.
We are proud to be an Equal Employment Opportunity employer, supporting the growth and health of our employees and community by embracing the rich diversity, needs and circumstances of all peoples and prioritizing opportunities to build a diverse and inclusive workplace. We do not discriminate based upon race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity, gender expression, age, status as a protected veteran, status as an individual with a disability, or other applicable protected characteristics.
If you require reasonable accommodation to complete a job application, pre-employment testing, a job interview or to otherwise participate in the hiring process, please contact the Cayuga Health Talent Acquisition team at .
I certify that the information contained in this application is correct and complete to the best of my knowledge. I understand that any falsification or omission of information may disqualify me from further consideration for employment or, if hired, may result in termination. In consideration for my employment, I agree to abide by the rules and regulations of the company, which rules may be changed, withdrawn, added, or interpreted at any time, at the company's sole option and without prior notice to me.
I understand that any hiring decision is contingent upon my successful completion of all of the Company's lawful pre-employment/post-offer checks, which may include a background check, drug screen, employment references, and licensing review. If I am made a conditional offer of employment, I agree to execute any consent forms necessary for the Company to conduct its lawful pre-employment/post-offer checks. Such checks will not be conducted until allowed under applicable federal, state, and local law. I understand if I have a criminal background, it will not automatically disqualify me from employment unless otherwise required by law. I agree to execute any consent forms necessary for the Company to conduct its lawful pre-employment checks.
I also understand that the Company is a drug and alcohol-free workplace and has a drug and alcohol testing program consistent with applicable federal, state, and local law. I understand that after a conditional offer of employment, I must submit to and pass a pre-employment drug test as a condition of employment.