Title: PPD Claims Associate
Rate of Pay: Commensurate with experience
FLSA Status: Non-Exempt
Employer: Joint Industry Board of the Electrical Industry
Department: EESISP
Reports to: EESISP Supervisors
Location: Flushing, NY 11365
JOB DESCRIPTION
Reporting to the EESISP Supervisors, under close direction and oversight, the PPD Claims Associate will perform various duties including but not limited to:
PPD Examiner duties include:
- Regular review of all resolved classified PPD cases both pre-cap and post-cap for settlement
- Negotiation of Section 32 settlements with attorneys, subject to approval by Supervision
- Provide status reports to Excess carrier on all previously classified cases requiring updates
- Scheduling annual (semi-annual) alive and well checks on all classified cases, and necessary follow ups including surveillance in appropriate cases
- Responsible for maintenance of adequate reserves on all classified cases
- Provide status reports to Senior Management on any and all cases on an as-needed basis
- Process payments utilizing software system on select cases
- Communicates with Excess carrier on cases where it applies
- Communicate with the members on various issues that may occur
- May schedule an IME if needed to review need for treatment
- Occasionally authorize medications for treatment
- Performs other duties and special assignments as deemed necessary
Serve as back up for active claims, in this capacity the Examiner will be responsible for the following duties:
- Review of electrical industry workers compensation claims and determine compensability
- File all required workers compensation forms timely
- Oversee medical management and investigations of claims
- Calculate payroll and compensation payment based on set guidelines
- Serve as liaison and interface with Magna Comp nurse and claimant as part of the review process
- Assign cases for investigations and review progress
- Prepare workers compensation claim for long-term disability
- Ability to evaluate the degree of disability and scheduled loss value
- Maintains professional relationship with all appropriate parties involved with the claim.
- Refers cases as appropriate to management.
- Actively executes appropriate claims activities to ensure consistent delivery of quality claims service.
- Develops and manages claims through well-developed action plans, continues to monitor and work the action plan to timely and appropriate resolution
- Analyze and processes workers’ compensation claims by investigating, research, and gathering information to determine the exposure on the claim
- Perform other duties and special assignments as necessary
Work Environment
This job operates in a professional office -- customer service environment. This role routinely uses standard office equipment such as desktop computers, phone, scanner, printer, keyboard, photocopiers, shredder and fax.
Physical Demands
Sedentary work environment with physical demands described are representative of those that must be met by an employee to successfully perform the functions of this job. This would require the ability to lift files, pull files/forms/books, stand, bending, shred documents, open/close filing cabinets as necessary.
Position Type/Expected Hours of Work
This is a full-time onsite 35 hours per week– Non-Exempt position. Days and hours of work are Monday through Friday 8:30AM-4:30PM.
Flexibility: Must be able to work overtime when necessary.
Travel - No travel is expected for this position.
Required Experience, Skills, and Qualifications
- A four-year college degree preferred, or a combination of school and/or equivalent experience
- Familiarity with all NYS workers compensation forms
- A minimum of 1 years of experience as a workers’ compensation examiner required
- Extensive knowledge of NYS Disability and Worker’s Compensation laws
- Excellent interpersonal, organizational, and communication skills
- Working knowledge of Microsoft Word & Excel
- Must be able to work independently and collectively
- Familiarity with WC claim reserve
- Must possess the ability to make sound judgment
- Strict confidentiality
Other Duties/Special Projects
Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities, and activities may change at any time with or without notice.
Reasonable Accommodations Statement To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. Reasonable Accommodations may be made to enable qualified individuals with disabilities to perform the essential functions.
Top benefits or perks:
As a team member at the Joint Industry Board, you will enjoy:
- · 10% of employer contribution to your 401K (before FICA gross-up reimbursement) without mandatory matching, vested immediately before FICA gross reimbursement.
- · Basic Pay + FICA reimbursement (Social Security and Medicare Tax reimbursed as weekly added to compensation) = total weekly compensation.
- · After completing 26 weeks of full-time employment from permanent hire date: Free health, dental, and optical insurance - The premiums are paid entirely by the Joint Industry Board subject to any PHBP Plan and Trustee modification. Coverage thru Magna Care PPO (Medical), Express Script for Prescription, DDS/Anthem Dental, In addition, eligible employees may use JIB Medical P.C.
- · Short Term Disability and Long-Term Disability.
- · NYS Paid Family Leave.
- · Jury Duty and Death in family bereavement days off.
- · 11 Holidays
- · 2 Floater Days (Special Days)
- · Birthday*
- · Paid Time Off
- · Paid Vacation
- · Two Retirement plan – JIB ERIP Defined Pension Plan with vesting and age requirement, fully funded by employer and the Local 153 Pension Plan
- · Life Insurance
