Claims Consulting Services

 

Employer Claims Management Responsibilities Training:

Employers have a key role in the successful management of a workers’ compensation claim, however not all employers may be well versed in the laws and procedures governing the adjudication of claims.  RiskAware’s claims consultants are all licensed adjusters that have the experience to set up the employer protocols and train employer’s staff to reduce litigation risks, maintain a strong employee-employer relationship, and successfully manage worker’s compensation.

Our Consultants provide training for the employer’s internal claims staff on the employer responsibilities that include:

  • Employer new loss reporting protocols
  • Produce of claims kits, posting notices to client sites,
  • Acquisition of medical provider directories.
  • Client accident investigation process
  • Proper communication protocols with carrier adjuster
  • Jurisdictional wage statement creation
  • Return to Work coordination.
  • Litigation process participation assistance.

RiskAware Claim Outsourcing Services:

For those employers, PEOs, and Temporary Staffing Firms that do not have the internal staff with expertise to manage workers’ compensation, RiskAware can be your outsourced claims management team and advocate with the insurance Carrier’s claims adjuster or Third-Party Administrator.  RiskAware will continuously monitor the employer claims via use of diary and carrier system access to ensure claims are proactively managed with a goal of reducing the claim life-cycle which includes:

  • Return to Work communication assistance to the PEO/Staffing company when necessary, with a goal of reducing carrier paid indemnity, where possible.
  • Litigation management assistance and carrier oversight for timely and appropriate E/C defense strategy.
  • Resolution and closing ratio monitoring
  • Discussion of resolution strategy and reserve justifications, as needed
  • Represent any carrier-coordinated claim reviews on behalf of the PEO /Staffing Company.
  • Provide multi-jurisdictional advice and guidance to the PEO/ Staffing Company WC Claims Management Team.

RiskAware Claims Quality Assurance Services:     

RiskAware’s claims consultants are all licensed claims adjusters with experience as claims supervisors, mangers, and corporate directors of claims within carriers.  Our consultants can perform quality assurance reviews and claims score cards to meet client objectives such as: 

  • Create claim file summary per loss with focus as outlined by project goals to include proper adjudication, meeting jurisdictional compliance guidelines, or financial / reserve adequacy.
  • QA and compliance scoring for PEO staff’s WC oversight to identify employer responsibility categories that need attention.
  • QA and compliance scoring for Carrier/TPA staff on WC claims handling to ensure that the staff is meeting the Carrier’s Best Practice guidelines for Adjudication by state.
    • Deliverables are focused on ways to assist the carrier with meeting EDI or compliance requirements by jurisdiction to avoid fines/ penalties.
    • Deliverables are focused on ways assist the carrier /TPA with claims staff support and training needs.

RiskAware Claims Valuation and Legacy Run-Off Services:

Risk Aware’s claim consultants can perform reserve adequacy reviews and manage legacy claim runoffs using the following process: 

  • Create claim file summary per loss with focus as outlined by project goals to include proper adjudication, meeting jurisdictional compliance guidelines, with a focus on the financial / reserve adequacy.
    • Focus is on the financial adequacy per loss to assist the PEO/Staffing Company with addressing Carrier collateral calls for loss sensitive programs and plans.
    • Valuation of loss exposure for buyer or seller pricing support during PEO/Staffing Company acquisitions.
    • RiskAware will act as the employer representative for PEO/Staffing company to manage or assist with Legacy book claims run-off.
    • Focus on resolving or closing files to reduce the carrier collateral calls and free up collateral for other PEO/Staffing company opportunities.