Workers Compensation Claims Examiner II

Banner Health Phoenix , AZ 85002

Posted 2 months ago

The future is full of possibilities. At Banner Health, we're excited about what the future holds for health care.

That's why we're changing the industry to make the experience the best it can be. Our team has come together with the common goal: Make health care easier, so life can be better.

The future of health care starts here. If you're ready to change lives, we want to hear from you.

Our Workers Compensation team works hard at supporting our injured Banner employees as they work to change the health care landscape in our communities. Our talented and passionate teams is looking for an experienced Workers Compensation Claims Examiner II.

Come bring your passion for excellence, and your desire to "make healthcare easier so life can be better" to the Banner Health Workers Compensation team. As a Workers Compensation Claims Examiner II, you will be supporting all Banner Health employees in the state of Arizona.

You will help to control medical costs by conducting investigations and help determine the appropriateness of treatments and disability for our employees. Your support is needed at our Corporate office in Central Phoenix (Central & Thomas).

Your pay and benefits (Total Rewards) are important components of your Journey at Banner Health. Banner Health offers a variety of benefit plans to help you and your family. We provide health and financial security options, so you can focus on being the best at what you do and enjoying your life.

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About Banner Health Corporate

Within Banner Health Corporate, you will have the opportunity to apply your unique experience and expertise in support of a nationally-recognized healthcare leader. We offer stimulating and rewarding careers in a wide array of disciplines. Whether your background is in Human Resources, Finance, Information Technology, Legal, Managed Care Programs or Public Relations, you'll find many options for contributing to our award-winning patient care.

About Banner Health

Banner Health is one of the largest, nonprofit health care systems in the country and the leading nonprofit provider of hospital services in all the communities we serve. Throughout our network of hospitals, primary care health centers, research centers, labs, physician practices and more, our skilled and compassionate professionals use the latest technology to make health care easier, so life can be better.

The many locations, career opportunities, and benefits offered at Banner Health help to make the Banner Journey unique and fulfilling for every employee.

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Job Summary

The primary purpose of this position, under the Claims Supervisor, is to administer claims and control medical costs and indemnity benefits for workers compensation injuries or illnesses. The Sr. Adjuster is responsible for high level investigations, handling all litigated claims, complex claims and subrogation recovery.

Essential Functions

Evaluates work injury claims and medical reports to determine appropriateness of treatments and disability benefits in accordance with jurisdictional statutes and rules. Refers cases to medical management as appropriate.

Proactively manage all claims in accordance with company standards. Ensure all medical and indemnity benefits are paid accurately and time.

Provides excellent customer service and benefit information to claimants. Communicates coverage and legal responsibilities to the injured employee, supervisor, attorneys, responsible parties, physicians and other medical providers.

Determines what appropriate legal notices and correspondence are to be issued and required by the Industrial Commission of Arizona. Determines if the claim is a reportable claim under the guidelines of the Occupational Safety and Health Act (OSHA) and assigns an OSHA status to the claim as required.

Conduct dispute resolution with claimants and/or their attorneys. Inform appropriate departments regarding the claimants disability status.

Conducts direct investigations including but not limited to background checks, written and/or recorded statement of the claimant, witnesses, interview managers, discuss with safety experts, physicians, obtaining police records and other documents and court records as the case develops.

Directs and monitors outside investigations which may include; video surveillance and background checks, photography of accident scenes or equipment or accident re-constructionists and witness statements.

Coordinates with the internal Nurse Case Manager to authorize medical treatments, evaluates progress of claim and coordinates consultations and referrals. Composes correspondence and reports to attending or independent evaluating physicians summarizing treatment and prognosis requesting opinions of current findings. Actively utilizes cost containment measures and programs, appropriate subrogation and vendors.

Develop, maintain and adhere to action plans and reserves on high level and complex indemnity claim while pro-actively managing claims to resolution. Document communications and claim management activities.

Establish and maintain cost drivers and data elements to ensure accurate NCCI and Medicare reporting. Identify settlement opportunities.

Negotiate settlements with claimants and their attorney. Ensure Defense follows all reporting requirements and properly defends Banner Healths interest at all hearing and trials.

Minimum Qualifications

Proficiency level typically attained through a combination of an Associates degree in a related field and seven to ten years of job related experience.

Must possess current knowledge of workers compensation rules, regulations, procedures and protocols. Prior litigation and complex medical claim handling required.

Must excel in detailed investigations, complex claim reserving and proven strategic claim resolution outcomes. Requires the ability to use effective verbal and written communications, while dealing with a variety of difficult and complex human relation situations. Must be a team player.

Must be able to organize and prioritize daily workloads to meet deadlines and work under pressure. Must have intermediate level of medical terminology and basic anatomy. License or certification may be required for some work assignments.

Requires the ability to work effectively with all common office software as well as excel pivot tables.

Preferred Qualifications

Prefer workers compensation license, or Associate in Risk Management certification or related in the field. Additional related education and/or experience preferred.

Additional related education and/or experience preferred.

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Workers Compensation Claims Examiner II

Banner Health