Compensation Claims Specialist
Reports to Regional Workers’ Compensation Manager.
Responsible for managing and monitoring Amazon’s Workers’ Compensation program at designated fulfillment center sites. Responsible for developing and collaborating successful partnerships between associates, third party administrators (TPAs), internal business partners and external service providers.
Essential Job Duties and Responsibilities
Ensures business is compliant with state specific Workers’ Compensation regulations and Amazon policies and guidelines. Acts as the point of notification and contact for associates regarding any incident or injury that could or has resulted in a Workers’ Compensation claim. Serve as an associate advocate.
- Meet weekly with on-site Medical and Safety to access and review all open claims and any potential new claims.
- Point of contact for all documentation regarding incident. This includes internal safety notify and investigation details as well as any health information relevant to the claim from outside medical providers and treatment notes. Health information is limited to medical related to the injury.
- Assess the medical, vocational, behavioral, etc. needs of an injured associate via a combination of face to face, telephonic and written correspondence as needed.
- Provide all relevant documentation regarding work related incidents to Safety, onsite healthcare providers, Leave of Absence (LOA) team and TPA to assist in the determination of compensability, recordability and recording keeping requirements. This includes determining mechanism of injury, work restrictions, and managing the information related to work related injury/illness.
- Initial and ongoing point of contact to internal and external business partners for the duration of the claim.
- Point of contact for all written and telephonic correspondence regarding the claim.
- Communicate with providers, both internal and external to review treatment notes, ask for clarification when necessary, follow-up after initial appointments as well as scheduling appointments in conjunction with TPA if a referral to a specialist is required.
- Ensures confidentiality of Workers’ Compensation claims records; including relevant health information related to the claim.
- Ensures that the TPA manages the claims diligently, partners with Risk Management and Legal (internal and external) to manage relevant claim details, implement plan for timely resolution of claims.
- Review medical notes as they relate to the claim and treatment to verify appropriateness.
- Review claims together with TPA for causation and possible subrogation opportunities.
- Partner with multiple departments to coordinate and manage Return to Work programs for employees to ensure that work restriction and transitional work guidelines are being adhered to. Provide transitional work letter to associates.
- Maintain consistent uniform records for each claim.
- Maintain and update the transitional work tracker form for the designated sites on a weekly basis.
- Review all open claims every 30 days for opportunities for claims management and partner with all relevant parties on a plan of action.
- Partner cross functionally to proactively address any re occurring root causes.
- Schedule, develop agenda and host all conference calls and claim reviews with TPA.
- Review all medical providers and/or panels annually and ensure Amazon is in compliance with state guidelines regarding panels. Where applicable, ensure all appropriate authorization and forms are signed and processed.
- Possess advanced computer skills, including Word, Excel and PowerPoint.
- Available for domestic and potentially international travel.
- 1 + years of experience is required.
- Demonstrated knowledge of Workers’ Compensation claims management related laws and medical and legal terminology
- Bachelor’s degree preferred
- Strong interpersonal and communication skills, with ability to professionally communicate both verbally and written with employees and outside partners, recognizing and appropriately responding to others’ perspectives.
- Must be well organized, detailed oriented, and able to adjust to changing priorities.
Amazon.com - 2 years ago
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