Workers Compensation Claim Specialist

Job Purpose or Objective(s):  The Workers’ Compensation Claim Specialist will provide careful diagnosis, treatment, and expedition of workers’ compensation claims while applying Occupational Safety & Health recordkeeping practices. You will report to the Workers' Compensation Adjuster, Manager.

Monday-Friday, 8:00am-4:30pm

Primary Tasks:

1.       You will assess and review complex claims ensuring compensability, proper identification of causation of the injury/illness, and directing medical care plans for the associate.

2.       You will review medical diagnosis, monitor all follow-up appointments ensuring medical providers and associates are proactive in their recovery and treatment.

3.       You will schedule surgeries and other medical treatment with authorized medical providers.

4.       Knowledgeable of Safety Policies, strengthening our understanding of the incident, and identifying willful or negligent conduct.

5.       Be able to triage compensable claims into applicable OSHA reporting tools such as the OSHA 300 record keeping log.

6.       Assign appropriate reserves and determine reimbursement money to medical providers, team members, and fee schedule for payments made to medical providers.

7.       Calculate injury leave, mileage, and submit to the accounting team for benefit payments. 

8.       Liaison between CNOSH and Workers’ Compensation on OSHA reporting

9.       Assist with internal case management responsibilities between CNHSA, CNOSH, and outside medical providers.

10.   Perform all other tasks as assigned.

Requirements:

·         Bachelor’s degree in general studies/a Licensed Registered Nurse (RN)/a Licenses Practical Nurse (LPN)/ or 10 years of practical experience in lieu of education

·         Workers’ Compensation Adjuster License or ability to attain License within 90 days of hire.

·         Ability to determine compensability and the need for subrogation.

·         Knowledge of Workers’ Compensation Systems

·         Knowledge of statutes to analyze situations.

·         5 years’ experience adjusting claims and reserving claims.

·         Knowledge of Medical Terminology

·         Knowledge of Occupational Safety & Health injury and illness reporting

 

1.       You will assess and review complex claims ensuring compensability, proper identification of causation of the injury/illness, and directing medical care plans for the associate. 2.       You will review medical diagnosis, monitor all follow-up appointments ensuring medical providers and associates are proactive in their recovery and treatment. 3.       You will schedule surgeries and other medical treatment with authorized medical providers. 4.       Knowledgeable of Safety Policies, strengthening our understanding of the incident, and identifying willful or negligent conduct. 5.       Be able to triage compensable claims into applicable OSHA reporting tools such as the OSHA 300 record keeping log. 6.       Assign appropriate reserves and determine reimbursement money to medical providers, team members, and fee schedule for payments made to medical providers. 7.       Calculate injury leave, mileage, and submit to the accounting team for benefit payments. 8.       Liaison between CNOSH and Workers’ Compensation on OSHA reporting 9.       Assist with internal case management responsibilities between CNHSA, CNOSH, and outside medical providers. 10.   Perform all other tasks as assigned. ·         Bachelor’s degree in general studies/a Licensed Registered Nurse (RN)/a Licenses Practical Nurse (LPN)/ or 10 years of practical experience in lieu of education ·         Workers’ Compensation Adjuster License or ability to attain License within 90 days of hire. ·         Ability to determine compensability and the need for subrogation. ·         Knowledge of Workers’ Compensation Systems ·         Knowledge of statutes to analyze situations. ·         5 years’ experience adjusting claims and reserving claims. ·         Knowledge of Medical Terminology ·         Knowledge of Occupational Safety & Health injury and illness reporting

About the Choctaw Nation

The Choctaw Nation is the third-largest Indian nation in the United States, with over 200,000 tribal members and more than 11,000 employees. The first tribe over the Trail of Tears, historic boundaries are in the southeast corner of Oklahoma. The Choctaw Nation's vision, "Living out the Chahta Spirit of faith, family and culture," is evident as it continues to focus on providing opportunities for growth and prosperity.

Benefits

• Free gym membership
• Free access to employee health clinic
• Free lunch for casino & resort associates
• Earned wages access once per week for hourly Associates
• Pet insurance
• Paid vacation / sick time
• Medical / Dental / Vision
• 401(K) with company match
• College tuition reimbursement
• Short-term disability, long-term disability, and family leave
• Employee assistance program
• Employee prescription program
• CNO Paid Life Insurance
• Teladoc
• On Site Dental Clinics (Jet Dental)
• On Site Mammogram Services
• Free diabetes and hypertension monitoring benefit (Livongo)
• Accolade- Concierge Benefits Program
• Wellness Program that equals savings on health insurance cost (Virgin Pulse)
• Maternity Care Program
• (Benefits provided by the Choctaw Nation are based on employment classification)

CNO was selected as a winner in both HRDUS' and Forbes' 2022 "Employer of Choice" competitions:

• Choctaw Nation of Oklahoma received recognition as one of six Best Places to Work in the United States as selected by HRDUS
• Choctaw Casinos & Resorts received recognition from Forbes as a Best Employer for Diversity in the Travel & Leisure category.
• Forbes also recognized the Choctaw Casino and Resorts as one of America's Best Employers for New Graduates.

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