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Sr Claim Analyst - Texas Non Subscriber Benefits Program in Houston, TX at Advance Auto Parts

Date Posted: 12/1/2018

Career Snapshot

Career Description

We are an Equal Opportunity Employer and do not discriminate against any employee or applicant for employment because of race, color, sex, age national origin, religion, sexual orientation, gender identity, status as a veteran and basis of disability or any other federal, state or local protected class:

**Can be based in Dallas, TX or Houston, TX**
SUMMARY

The Sr. Claim Analyst – Texas Non Subscriber Benefits Program is responsible for successful administration of the Texas non-subscription occupation injury benefit program in the State of Texas.  This role will also assist in other state workers’ compensation claims management program under the direction of the Claims Manager. 

The Claims Analyst is responsible for ensuring effective claims and benefit management and self-administration by coordinating with outside vendors and reviewing claims.  This position is designed to control workers’  claim costs by identifying loss control opportunities,  reviewing subrogation claims; managing file review and providing direction to claims adjusters and external defense counsel; reviewing and approving reserve and settlement authority within assigned parameters; assisting adjusters and defense counsel with their investigations and defense processes; ensuring consistent handling of claims & compliance with internal & external procedures & regulations; analyzing workers’ compensation claims trends and preparing claim allocation reports. 

This position will create our first self-administered program and requires high coordination with internal and external partners including Human Resources, Store Operations, Safety, Benefits, Payroll, Legal Departments, and Supply Chain to ensure the company is in compliance with all applicable internal policies, federal and State regulations.  This position will act as our subject matter expert on Texas non-subscription regulations and programs.  This position will assist the Director of Risk Services and VP of EHS and Risk with management of the ERISA welfare plan which provides the non-subscription coverage.  This position will work directly and manage medical and nurse case management providers, medical doctors, and other service providers. 

ESSENTIAL DUTIES AND RESPONSIBILITIES include the following.  Other duties may be assigned.

 

  Design and manage our administration strategy.  Adjust claims to ensure compliance with claims handling instructions, achievement of performance goals, track workers’ compensation trends, identify opportunities to reduce losses based on claim trends and/or specific issues, and assist with claims service issues. 

In other states Supervise workers’ compensation claims adjusters.

 

Manage field nurse case managers and assist with defense counsel on their investigation efforts.  Assist in the evaluation of individual workers’ compensation claims in regard to reserve and settlement authority, claim handling direction, and selection of individual adjusters and claim service vendors. 

Directly impact by reducing the costs and duration of claims.  Administer Advance Auto Parts Claims Management Program, including:

Review and processing claims and legal documents.

Develop and maintain cross functional relationships to ensure full organizational support and participation with Workers’ Compensation claims teams and investigation process and programs.

 

  Review and analyze workers’ compensation files as assigned; ensure adequate reserves; review workers’ compensation subrogation claims; authorize 3rd party recoveries; partner with subrogation adjusters and Defense Attorneys to negotiate 3rd party recovery when necessary. Track, monitor and report on workers’ compensation claim trends to management.  Monitor claim data quality from third party claims administrators and address deficiencies.

 

  Authorize and manage workers’ compensation claim settlements and/or reserve increases within claim authority limits; convey recommendations to management relating to claim settlements anticipated to exceed established authority level.

 

  Partner with Operations, Asset Protection, Benefits, Human Resource Departments, EHS (Safety) and Legal to ensure compliance with company policies, ADA, state workers’ compensation laws and other regulations. Establish diaries on claims to ensure focus on resolution and adherence to protocols.

 

  Manage litigation process in conjunction with TPA and work with Defense Attorneys to resolve assigned claims; participate in settlement negotiations and pre-trial and/or mediation conference calls.  Assist in selecting and monitoring competent workers’ compensation defense attorneys.  Proactively notify and work with management on claim files that are approaching and/or that exceed authority for this position.  Track, monitor and report litigation trends to management.

  Administer workers’ compensation claim allocation process and related reporting.

 

Collaborate with and assist the Risk Management Team Members, Safety and other business partners to identify adverse loss trends and to identify and develop strategies to reduce injuries. May act as a designated Risk Management representative at various internal and external meetings including settlement conference or mediations.  Conduct special analysis/projects/assignments as requested.

 

  Assist with monthly roundtables, prepare quarterly claim file reviews for Texas, and participate in TPA claim reviews in other states.  Conduct annual audits with TPAs and broker claims consultant to ensure that claims are proactively managed to conclusion in accordance with contractual agreements and that established reserves accurately reflect the anticipated value of pending claims. 

  QUALIFICATIONS

The requirements listed below are representative of the knowledge, skill, and/or ability required.  Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Highly detail-oriented and thorough while also exhibiting exceptional customer service and negotiation skills.

 

Ability to work effectively both independently and in a collaborative team-oriented environment; able to meet deadlines while making priority adjustments as needed.

 

Understand and apply multi-state workers’ compensation laws and regulations

 

Ability to apply a working knowledge of claim investigation: adjusting, medical management and adjudication procedures

 

Ability to manage confidential information while using sound judgment and discretion

 

Ability to establish and maintain effective working relationships with a multitude of business partners, internally and externally

 

Strong oral/written communication skills: bilingual Spanish is a plus but not required

 

Strong organizational skills and self-motivation

 

Proficient in Microsoft Office and PeopleSoft applications

 

Available for limited overnight travel up to 5% of the time

EDUCATION and/or EXPERIENCE

Bachelor’s degree and 10 years related professional experience; or equivalent combination of education and experience.  5+ years should be in a claims department

Deep experience with Texas Non-Subscription programs is required

Experience with TPA and Self Administration required

Prior claims adjusting experience is required. 

Prior claims processing experience is required.

Supervisory experience related to claims adjusting preferred.

CERTIFICATES, LICENSES, REGISTRATIONS

Licensed Claims Adjuster a plus (multi-states).  Texas licenses / certifications required

Career Requirements

We are an Equal Opportunity Employer and do not discriminate against any employee or applicant for employment because of race, color, sex, age national origin, religion, sexual orientation, gender identity, status as a veteran and basis of disability or any other federal, state or local protected class.