Claims Causation Specialist

<strong>AF Group (Lansing, Mich.) and its subsidiaries are a premier provider of innovative insurance solutions. Insurance policies may be issued by any of the following companies within AF Group: Accident Fund Insurance Company of America, Accident Fund National Insurance Company, Accident Fund General Insurance Company, United Wisconsin Insurance Company, Third Coast Insurance Company, or CompWest Insurance Company.</strong>

Wisconsin, USA

AF Group

<h3><strong>Attention:</strong></h3> <p><strong>From Dec. 7, 2020 until Dec. 27, 2020, we will be undergoing a transition to a new recruitment technology platform. During that time, we will not be able to accept applications.</strong></p> <p><strong>We apologize for any inconvenience this may cause.</strong></p> <p><strong>We appreciate your interest in joining our team, and would love for you to come back on Dec. 27 to apply.</strong></p> <p><strong>Thank you!</strong></p>

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Competitive Compensation and Benefits Package

Overview: <p>This position will serve as a technical expert with regard to ensuring compensability decisions are made based on detailed investigation and facts surrounding the alleged mechanism of injury. This position will support cost containment programs, and alternative duty jobs to assist clients with individual job modifications, and alternative work duties to reduce the potential for compensable injuries. This position supports the stay-at-work program for the enterprise.</p> <p>There are five main types of investigations conducted by this position: 1) Repetitive motion, 2) Environmental Disease, 3) Subrogation, 4) Large Loss, and 5) Ergonomic Assessment. These investigations are used to determine injury compensability and assist with returning injured workers to work in a timely manner. This position requires managing a field workload. This position will work within the enterprise in terms of joint or otherwise cooperative endeavors related to their area of expertise.&nbsp;</p> <p>This position is responsible to conduct claim investigations to determine the causation of injuries by evaluating injured workers&rsquo; job-related duties while assessing ergonomic and occupational disease impacts. This position develops recommendations to reduce and eliminate potential repetitive motion injuries at work with a key focus on the stay-at-work program. &nbsp;&nbsp;</p> <p>The Claims Causation Specialist role requires attendance at national and state-specific industry conferences and reporting to management up-to-date methods and industry changes that may impact business decisions.</p>
Responsibilities: <ul> <li>Conduct and coordinate injury investigations on all assigned claims to provide accurate facts for disposition, including on-site and desk investigation analysis.</li> <li>Analyze intelligence information and make a determination for further investigation claims utilizing available resources.</li> <li>Conduct job evaluation with clients to understand forensics and ergonomics of injured worker&rsquo;s duties and responsibilities.&nbsp;</li> <li>Follow established policies and procedures for conducting causation evaluations.</li> <li>Serve as technical expert on repetitive motion injury analysis.</li> <li>Provide communication with the policy holder and internal Loss Control Representative for any safety hazards or potential ergonomic hazards identified.</li> <li>Assess various machinery and operations in evaluating and establishing negligence and 3rd party liability for subrogation process.</li> <li>Partner with claim handler, to assess client&rsquo;s industrial hygiene, including equipment maintenance and calibrations, pre-survey studies and research, completion of technical field evaluations and final reports.</li> <li>Provide accurate and timely information to all internal and external stakeholders to address claim status. Include other inquiries such as questions on subrogation recovery, reserve adequacy, and underwriting risks.</li> <li>Work with corporate claims resources and participate in the development of data analytics for the causation investigation program.</li> <li>Consistently monitor workflows to maximize efficiency.&nbsp; Maintains an acceptable level of service, customer satisfaction, and retention.</li> <li>Analyze trends and completes comprehensive and detailed reports.</li> <li>Assist with evaluation of training needs and design and develop training modules, materials and evaluations related to causation and subrogation for internal and external customers as needed.</li> <li>Apply up-to-date technical knowledge of investigative core functions.</li> <li>Use working knowledge of American Society of Mechanical Engineers (AMSE) and Occupational Safety and Health Association (OSHA) regulations.</li> <li>Deliver presentations as needed.</li> <li>Use independent judgment in all areas of responsibility, while considering departmental priorities.</li> <li>Update metric tracking documents monthly.</li> <li>Conduct environmental disease investigations by analyzing data provided by a third party Certified Industrial Hygienist to compare the results to the ACGIH, OSHA and NIOSH recommendations.</li> </ul> <p>This position description identifies the responsibilities and tasks typically associated with the performance of the job. Other relevant essential functions may be required.</p>
Requirements: <p><strong>EDUCATION OR EQUIVALENT EXPERIENCE:&nbsp;</strong>&nbsp;</p> <p>Bachelor&rsquo;s degree in business, Occupational Safety, and Health, Ergonomics, Mechanical Engineering, or related field of education. &nbsp;Continuous learning required, as defined by the Company&rsquo;s learning philosophy. Certification, or progress toward, highly preferred and encouraged (Certified Professional Ergonomist (CPE) or Certified Safety Professional (CSP).</p> <p><strong>EXPERIENCE:</strong></p> <p>With proper education credentials, minimum five years of insurance claims investigations and/or ergonomics assessment experience required. Extensive experience in Occupational Health, Workers Compensation Case Management, Ergonomics, Safety, Industrial Hygiene, or other related field required. &nbsp;Workers compensation experience and/or experience in a property/casualty insurance organization preferred. Experience in Environmental Disease or Subrogation preferred.</p> <p><a target="_blank">Causation Specialist:</a></p> <p>Minimum three years relevant experience that provides the necessary skills, knowledge and abilities. Workers Compensation Insurance, ergonomics, and Industrial Hygiene experience preferred.</p> <p><strong>SKILLS/KNOWLEDGE/ABILITIES (SKA) REQUIRED:</strong></p> <ul> <li>Technical knowledge of Workers&rsquo; Compensation or relevant insurance expertise.</li> <li>Technical knowledge of insurance administration, claims management, or relevant insurance expertise.</li> <li>Knowledge on repetitive motion injury analysis.</li> <li>Knowledge of insurance fraud and other relevant civil and criminal laws.</li> <li>Advanced working knowledge in investigating ergonomic and repetitive motion injures with a focus on American Conference of Government Industrial Hygienists (ACGIH) standards desired.</li> <li>Strong interpersonal and superior communication skills, including verbal and professional writing.</li> <li>Strong report preparations and presentation capability.</li> <li>Strong background in word processing, spreadsheets, and video editing software programs required with knowledge of Microsoft applications.</li> <li>Ability to analyze and interpret documents for accuracy in reference to technical, legal, and financial information.</li> <li>Ability to effectively exchange information clearly and concisely, present ideas, and respond to questions as appropriate, both in oral and written communications.</li> <li>Up-to-date technical knowledge of investigative core functions.</li> <li>Working knowledge of American Society of Mechanical Engineers (AMSE) and Occupational Safety and Health Association (OSHA) regulations</li> <li>Working knowledge of applying ergonomic assessment tools including. ANSI Z365, ACGIH TLV for Hand Activity Level, Washington State Lifting Calculator, Liberty Mutual Handling Material Tables</li> <li>Working knowledge of using a force meter and noise dosimeter</li> <li>Ability to quickly make decisions and comprehend the consequences of various problem situations and take appropriate actions and/or refer problems for necessary decision making.</li> <li>Ability to organize and prioritize multiple assignments.</li> <li>Ability to work tight timelines when necessary.</li> <li>Ability to maintain confidentiality.</li> <li>Ability to perform field assignments at locations outside the office.</li> <li>Ability to work with minimal supervision.</li> <li>Ability to identify workflow options to create and improve investigation process.</li> <li>Ability to continually exercise discretion and independent judgment in matters of significance.</li> <li>Ability to indentify industry trends and present emerging ideas for change management.</li> </ul>