Analyst, HR Services

• Reviews and evaluates all claims for completeness and clarity of data; supporting documents, as needed, to ensure compliance with policy and regulatory requirements.
• Determines appropriateness and amount of employee’s claims; investigates individual claims for eligibility for workers' compensation benefits; ensures that all legal and procedural requirements are met for the processing of claims, in order to ensure proper and timely payment to employees.
• Design and implement training and orientation programs to disseminate claim processing procedures to employees.
• Assembles appropriate medical information and facts regarding claims for cases pending litigation if required.
• Communicates and interacts with medical professionals, support agencies and others to monitor and assess claims and verification of documents.
• Prepares all necessary forms, records and documentation, to include statistical analyses and reports, for all claims assigned, as required by various regulatory agencies.
• Makes strategic recommendations for reducing the frequency and severity of claims; designs and develops data bases, performs integrated data analyses, and prepares reports.
• Processes assigned claims and performs other job-related duties as assigned.

Averis