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Career Story: Workers' Compensation Case Analyst

Workers' Compensation Case Analyst

Job Title: Workers Compensation Case Analyst

Type of Company: My company provides Workers' Compensation insurance to New York state municipalities.

Education: BA, English and Psychology, SUNY-Albany

Previous Experience: I started work for my company right out of college. I began as an administrative coordinator and worked up to case analyst.

Job Tasks: As a Workers' Compensation case analyst I handle claims made by our members' employees. Our members are state municipalities from all over New York. When workers are injured they submit a claim stating what happened and how they've been hurt. Injuries can vary from something as insubstantial as dust in a highway worker's eye to something as severe as death.

I handle the claim from the time it is submitted. My job includes investigating the causes of accidents and determining whether or not the injury is valid and compensable. If I determine that it's valid, I coordinate benefits for lost pay at work (if that's appropriate). I also coordinate health care and grant authorizations for medical treatments including therapy, MRIs and surgery.

Most claims are arbitrated by the Workers' Compensation Board of NY state and in cases where there are differing opinions judges at the Workers' Compensation Board make a final ruling on the claim. My office is represented by attorneys I work closely with, prepping them on my files and giving them direction on how to proceed and what arguments to make.

In the final stages of a claim I can negotiate settlements with the injured employee to cover expenses related to expected medical treatment in the future and the expected lost wages from work. Once a settlement has been processed, the claim is closed and no further work is necessary. However, most workers' compensation cases do not end this way, as most are not severe enough to warrant a large settlement. More often the injured employee receives medical treatment which allows him to go back to work and resume a normal life.

Best and Worst Parts of the Job: The best part of my job is helping people who are in need. When I speak with an injured worker and make him aware of how workers' compensation works (most don't have any idea what this is until they need it) and I am able to help them get the best care as fast as possible, that is what truly makes my day. In my business there are other companies who do not always have the same speedy standards for claims resolution. When I shock providers by how fast I respond to their requests, that is really a source of pride.

The worst part of my job is when rulings at the Compensation Board are made that seem not to coincide with the law as written. As a case analyst I am also responsible for paying bills and nobody likes paying bills, but worse then paying bills is having to deal with some bill collectors. Sometimes a bill is held for payment and that leads to calls for people looking for the payments.

Job Tips: Entering the insurance field may not be on the top of your list of choices, but the insurance business is a growing field and tends to have good job security. If getting involved in insurance is something you are looking into the best advice I can give you is to take some courses in biology, computers and English composition. Knowing the human body and medical terminology will help you to decipher medical reports written by doctors; advanced computer skills will make computers your friends, and learning to write simple, lucid English will help you in any field really.

Additional Thoughts: In my job and in any job, public speaking is a great asset. If you have any issues with speaking in front of groups, big or small, you should take the steps necessary to overcome them. There are many courses and groups in college that can help you if needed; one is called Toast Masters. Check it out.

Good Luck and have fun! If you have fun everyday, it doesn't seem so much like work.

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