Talented professional with 30 years of experience. Thoughtful,, a problem solver, results driven and have a strong work ethic. Very resourceful with great communication skills, team player and easily adapt to new surroundings. Highly detailed and organized with ability to work with no supervision. Has extensive knowledge of Workers Compensation, Unemployment and Federal Safety regulations. Ability to work effectively with agencies with state, public, private and non-profit sector.
Responsible for management, monitoring and reporting workers' compensation claim programs state/federal levels. Continual claims oversight until resolution. Oversight for incident, injury accident reporting and Federal OSHA regulation tracking,
Conduct office ergonomic evaluations, provide written recommendations outlining accommodations needed, rational and costs associated with such tools for employee to management.
Represent the Nevada Department of Transportation at workers' compensation administration hearings.
Assist in the review and analyzing of Federal and State DOT drug and alcohol program to include reviewing training material Design and develop course curriculum, including writing objectives, preparing course descriptions, outlines, and leader's guides to ensure they meet Federal and State requirements for training aids, supplemental course materials, participant workbooks, and other handout materials. Act as Liaison between State Risk Management and workers' compensations Third Party Administrator (TPA)and injured employee.
Conduct independent investigation and analysis of suspected fraud violations, to include (Unreported Earnings, Tip and Lead referrals, Identity Theft, Fictitious Employer Accounts, Suspicious Social Security Numbers and Back Pay Awards), Obtain, examine and properly document case.
Conduct investigations. document all evidence considered in issuing determinations/or clearing issues.Ensure fact finding/case material meets Department of Labor requirements.
Write, and distribute non-monetary decisions within the 21 day time frame established by Department of Labor.
Cases meeting strict criteria are subjected to advanced fraud preventative and corrective actions and discovery. a) Cases identified by unit investigators are reviewed with the unit supervisor as possible prosecution targets. Approved cases are referred to assigned investigators who perform prosecution case preparation for submission to Nevada's Attorney General. Case preparation must comply with State law, Attorney General directions, regulations, Division policy and procedures. b) Conduct Field/Joint investigations with Contributions staff as relating to employer/claimant collusion. Write appropriate reports and take appropriate legal steps to remedy. c) Audit of employer wage records and benefits cross matches in both automated and manual methodologies. Refer findings to fraud processes for review and appropriate disposition. d) Investigate substantiated allegations of identity theft in conjunction with appropriate law enforcement agencies.
Complete computer inputs accurately and within established time frames in accordance with State and Federal requirements.
Responsible for the timely investigation and processing of claims for all claimants. Demonstrate the effective use of case management tools and resources provided by BDA. Complete appropriate action on claims and respond to claimant inquires in a timely manner. Prepare claims for final determination as expeditiously as possible.
With monitoring by Unit Supervisor and/or mentor, develop an effective caseload management system to meet production requirements. Demonstrate a progressive ability to manage an increased number of claims.
Actively participate in classroom training. Accept feedback on performance and seek to solve problems. Consistently demonstrate an increased understanding of the disability program. Demonstrate solid analytical skills and capacity for independent decision-making.
Provide quality customer service internally and externally utilizing all relevant and professional skills. Exhibit a professional and respectful behavior to staff, customers and general public. Exhibit positive attitude, be dependable, and maintain cooperative and productive relationships with co-workers, supervisors and subordinates.
Conduct fair and impartial administrative hearings for unemployment benefits pursuant to Nevada Administrative Codes and Nevada Revised Statutes, in accordance with the Department of Labor.
Issue prompt written decisions based on testimony and evidence provided during the administrative hearing.
Responsible for reading, organizing and making case files for administrative hearings. Determine if other issues will be addressed in the hearing. Provide the office staff the date and time of the scheduled hearing. Ensure hearing notices are issued in a timely manner.
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