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Bilingual Workers Compensation Claims Administrator

Company Ashley Furniture Homestore
Location Redlands, CA
Update 5 Day ago
300
Help us help our customers realize their dreams of a beautiful home! -Join The #1 Furniture Company-Join The #1 Furniture Brand
Ashley Furniture Industries, Inc. is the largest manufacturer of furniture in the world. Established in 1945, Ashley offers one of the industry’s broadest product assortments to retail partners in 123 countries.
Design, Build, Deliver:
Using our internationally acclaimed in-house design team, we create the look without paying expensive design fees. Then, by adhering to some of the most efficient production standards in the world, we are able to maximize productivity and minimize waste, generating additional savings for you. Finally, all orders are filled from strategically located regional warehouses and are serviced by our own fleet of trucks, the largest in the industry.

http://ashleyfurniture.avature.net/ashleyfurniturecareers?jobId=3457&source=Monster Click Here to Apply The purpose of this position is to minimize financial loss resulting from Workers’ Compensation claims made against the company. This position is responsible for providing quality oversight and management of each claim in a timely and cost effective manner while ensuring injured workers are receiving appropriate care and timely benefits as to work-related injuries.

ESSENTIAL DUTIES & RESPONSIBILITIES

• Online reporting of all worker’s comp claims into the insurance company’s website.

• Review, investigate and report all WI AFI worker’s compensation claims. Communicate with the employee, his/her supervisor to determine if claim will be time or wage loss.

• Manage work comp files and make sure to all parties are kept updated regarding : Dr. visits, change in medical status/care, updates to work restrictions, discharge from care, and claim denials.

• Conduct frequent and ongoing reviews of each case to ensure the file is reserved appropriately, documented timely, and that the insurance adjuster has implemented an aggressive action plan to resolve each claim in a timely and cost efficient manner.

• Coordinate and supervise transitional duty employees and generate / approve eCOS on a timely basis for employees off on WC leave and employees on reduced wage. Make sure employee, supervisor and Human Resources are all updated on changes.

• Process all incoming mail. Verify claim information and forward to insurance company. Research any that don’t have claim numbers or that are not for active employees.

• Timely maintenance of claim data in Intelex computer program to insure accurate information for the Quality Pays program.

• Research billing and payment issues between employees, medical facilities and insurance company. Answer employee questions and concerns regarding benefits and claim status.

• Administrative support including copying, filing, shredding, scanning, time sheets, weekly/quarterly reports.

• Maintain attendance records for doctor appointments and excused absences for injured workers.

• Complete other assignments and special projects as requested.

• Actively participate in departmental meetings, training and education.

• Works with Health & Safety Department to investigate safety violations for possible reduction in benefits or potential for subrogation recovery.

Job Requirements
Education:
• Required: Associate degree in Human Resources or Medical field or equivalent experience.

Experience:
  • 4 years in Human Resources or Medical/Insurance related occupations.
  • Bilingual (English/Spanish)
Knowledge of:
• Worker’s Compensation laws and benefits
• Insurance claims processing procedures.
• Documents management system (scanning, databases)
• Working knowledge of Continuous Improvement.
• Record Management (medical releases and HIPPA regulations)

Skills and Abilities:
• High attention to detail and accuracy.
• Effective time management and organizational skills.
• Effective interpersonal communication skills.
• Analyze, solve and timely respond to questions and problems.
• Maintain confidentiality.
• Handle multiple projects simultaneously within established time constraints.
• Highly skilled in Microsoft Office Suite (Word and Excel), Internet.
• Respond professionally to situations with difficult employee/ vendor/ customer issues or inquiries.
• Work with minimal to no supervision

We are an equal opportunity employer and provide a drug free working environment. While Ashley appreciates the interest of all candidates only those meeting