Trinity Health Workers Compensation Claims Technician in Livonia, Michigan
Responsible for assisting System Office Workers' Compensation (WC) Claims Managers and Ministry Gatekeepers/Workers' Compensation Coordinators by coordinating the WC claim process activities between System Office, Ministries and Third Party Administrator (TPA). Monitor WC data integrity, provide communications, problem-solving and guidance to Gatekeepers/Workers' Compensation Coordinators. Ideal candidate will have working knowledge of Workers' Compensation claims process. Must possess proficiency with office information systems including e-mail (e.g. Outlook), fax, and e-conferencing applications (e.g. WebEx). Proficiency in use of other standard Desktop applications including MS PowerPoint, Excel, and Word required. Familiarity with MS Access a plus.
Responsible for assisting System Office Workers' Compensation (WC) Claims Managers and Ministry Gatekeepers/Workers' Compensation Coordinators by coordinating the WC claim process activities between System Office, Ministries and Third Party Administrator (TPA). Monitor WC data integrity, provide communications and guidance to Gatekeepers/Workers' Compensation Coordinators. Maintain database of Ministry points of contact and provide administrative support functions.
Knows, understands, incorporates and demonstrates the mission, vision and values of Trinity Health in behaviors, practices and decisions.
Serves as the primary point of contact for Ministry Gatekeepers/Workers' Compensation Coordinators relating to submission and processing of WC incidents in the Trinity Health Employee Incident Reporting ('THEIR') module within the Marsh ClearSight STARS application. Provides guidance, communication and problem-resolution as needed, and appropriately resolves and/or triages issues.
Ensures timely resolution/reassignment of WC incidents requiring correction, and updates database accordingly.
Independently produces summary claim reports and other template reports as requested. Assists the Ministries with creating incident and claim reports through the use of template reports in STARS. Assists WC Coordinators/Gatekeepers with TPA claim system and reporting functions.
Independently prepares and reviews reports to determine claims that have reached Self-Insured Retention and follows up with Claim Managers for next steps.
Reviews all incoming correspondence, and places and revises diary dates in Outlook and/or STARS. Files correspondence and documents as appropriate.
Coordinates and assists the WC Claims Managers with claim reviews; coordinates, schedules meetings, and prepares material for semiannual claim reviews for each Ministry, including RHM WC Coordinators/Gatekeepers, Third Party Administrator Claims Representatives and Supervisors, as well as Defense Counsel.
Contacts Defense Counsel as directed by WC Claims Manager; composes correspondence/mail and form letters as directed; transcribes dictation and processes as directed.
Independently coordinates and performs other claim unit support functions as assigned by WC Claims Managers including scheduling, calendar management, special projects, travel arrangements, and expense tracking while ensuring timely work completion and effective communication.
Maintains and updates Workers' Compensation databases and contact lists, including coordinating with other divisions to ensure current and accurate Gatekeeper information in STARS.
Reviews and edits STARS data integrity reports as appropriate. Independently verifies data integrity with Third Party Administrator and Data Analysts.
Independently coordinates file audits with internal and external auditors; prepares file for review. Completes final presentation of collected data.
Independently maintains and updates desk and claim procedure manuals and training materials.
Maintains and updates unit's portion of IRMS website and shared drive, including adherence to organizational structure.
Independently creates and implements orientation onboarding process for new Gatekeepers/WC Coordinators and other WC claims support roles.
Prepares Power Point presentations for Trinity Health Leadership, RHMs and/or outside counsel as directed.
Coordinates meetings, conferences, webinars and seminars for large groups including creating and distributing notifications, tracking responses and all other applicable duties associated with presentations made to large groups, in person. as well as in electronic format.
Maintains working knowledge of applicable Federal, State, and local laws and regulations, Trinity Health Corporate integrity program, Code of Ethics as well as other policies and procedures in order to ensure adherence in a manner that reflects honest, ethical and professional behavior.
Must possess a comprehensive knowledge of insurance claims processing and
administration. High school diploma plus a minimum of five (5) years related work
experience. Experience as a paralegal, legal secretary or an executive level assistant
in insurance industry and additional academic training in other general undergraduate
study is a plus.
- Proficiency in medical and/or legal terminology. Workers' Compensation knowledge a
- Must possess ability and willingness to plan, organize and accomplish tasks accurately,
efficiently and in a timely manner for multiple team members.
- Strong verbal and written communication skills and the ability to effectively listen discuss
and respond to inquiries and requests.
- Must possess proficiency with office information systems including e-mail (e.g. Outlook),
fax, and e-conferencing applications (e.g. WebEx). Proficiency in use of other standard
Desktop applications including MS PowerPoint, Excel, and Word required. Familiarity
with MS Access a plus.
- Demonstrated aptitude for learning new systems and processes. Proficiency in use of
Marsh ClearSight STARS system a plus.
- Must possess strong telephone skills and be proficient in the operating of
telecommunication equipment. Proficiency in typing and document formatting.
- Basic knowledge of webinar processes and technology (e.g. WebEx) and the skill
necessary to plan and conduct mass electronic sessions required.
- Must be results and action-oriented, attentive to detail, use good judgment, and
demonstrate respect for others.
- Must possess ability to function in a dynamic, multi-task environment, be able to cope
effectively with ambiguity and change.
Must be comfortable operating in a collaborative shared-leadership environment.
Must possess a personal presence that is characterized by a sense of honesty, integrity
and caring, with the ability to inspire and motivate others to promote the philosophy,
mission, vision, goals and values of Trinity Health.
PHYSICAL AND MENTAL REQUIREMENTS AND WORKING CONDITIONS
- Must be able to set and organize own work priorities, and adapt to them as they change
frequently. Must be able to work concurrently on a variety of tasks/projects in an
environment that may be stressful with individuals having diverse personalities and work
styles. Ability to concentrate, meet deadlines, work on several projects simultaneously
and adapt to interruptions.
- Operates in a typical office environment with areas that are well-lit, temperature
controlled and free from hazards.
- Must be able to communicate clearly, effectively and frequently, in person, through email
and over the phone, with people in a number of different locations.
Hearing is needed for extensive telephone and in person communication.
Manual dexterity is needed in order to operate a computer keyboard.
Must be able to travel to the various Trinity Health sites or other related locations as
assigned, i.e., court, attorney offices (less than 3%).
- Moderate physical activity, lifting and bending is required.
The above statements are intended to describe the general nature and level of work being performed
by people assigned to this classification. They are not to be construed as an exhaustive list of duties
Job Number: 00108160
Location: Livonia, MI
Organization Name: Trinity Health
Facility: SO - Trinity Health System Office
Employment Type: Full time
Shift: Day Shift