Risk Rep

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The Risk Representative position will support the administration and management of the Vallarta’s Property and Casualty program. Assist in the administration of the Safety Program, Workers compensation, General Liability programs including TPA audit/quality control, claim file review, litigation and analysis of exposure and reserve accuracy.

The Risk Representative’s responsibilities include, but are not limited to:

• Setting up the initial file for injury and determining if this is a claim that needs to be reported to the insurance company, it is a First Aid claim or if it is a non-industrial incident
• Investigate new losses and report losses to TPA/Carrier with supportive documentation  
• Liaison between Operations and TPA for workers compensation claims process 
• Maintain an accurate log of all injuries received and complete employer level investigation
• Maintain updated medical status on all open files
• Assists the Safety Department by keeping track of various Safety incentive projects 
• Maintain and manage multiple report using spreadsheets 
• Participates in claims review with the insurance carrier/TPA
• Coordinate return to work program with injured worker, Stores and TPA
• Documentation of file activities in accordance with established policy and maintenance of an effective diary management system to ensure timely handling of claims 
• Maintain constant communication with Store personnel and Store Management to assist with Safety related issues and claims management   
• Review and approving medical bills received from the clinics as it pertains to First Aid incidents/charges
• Review and process subpoena 

Assist with the management of customer complaints and resolution 

Qualifications

General Roles & Responsibilities:

1. Daily data entry is required into the Workers Compensation log and into the database (Origami)
2. Daily communication with injured workers, stores and insurance company, and attorney involved in the file
3. Gathering weekly reports from all stores
4. Follow-up with store management, vendors and injured workers on a daily basis or as issues arise
5. Provide Human Resources department and Benefits with updated information as it affects their respective departments
6. Assist in the daily administration of Vallarta’s Safety program, which includes the collection of various Safety documentation, assist with the Safety incentive program and logistic support for all stores 

Job Requirements:

Education: 

• High School Diploma or Equivalent – Required
• College Degree Preferred
• Professional Certification IEA desirable  

Experience: 

• 1-year experience in handling Workers Compensation claims Preferred
• Must have detail oriented with financial date and statutory due dates 
• Medical, legal and/or insurance related experience Preferred

Knowledge:

• Experience with managing a claims Database system
• Advanced technical knowledge and skills in claims handling Preferred
• Proficiency in Microsoft applications (e.g.-Excel, Outlook, Word, Power Point).
• Typing 35 WPM
• Experience with 10 key, fax and multi line phone system.
• Bi-Lingual desirable

Skills and Ability: 

• Good communication skills required
• Good interpersonal skills, dealing with employees. Dealing with delicate situations and confidential information
•  Ability to interact and work in conjunction with other department within the company.
• Ability to work independently
• Superior project management and time management skills
• Analytical and Problem-Solving skills recommended