Strategically manage Worker Compensation claims to mitigate losses through interactions and coordination between diverse internal and external providers to ensure the program outcomes are met. Develop, design, implement, and manage processes that support the strategy and overall goals of the program. Claims management of all cases to review for appropriateness, promoting the modified duty /RTW program and use of WorkCare.
Essential Job Functions
- Develop, train and mentor site workers compensation coordinators to ensure the success of the overall site WC program
- Ensure all sites understand recordkeeping to ensure compliance and accuracy
- Determine if training is required and provide or refer to appropriate resource
- Review all cases entered into recording (ERS) to ensure accuracy
- Communicate and ensure that sites understand that modified duty will be provided at all times
- Collaborate with third party Occupational Health Physician to review those lost time cases “as if in the US”
- Participate in quarterly claim reviews
- Maintain open and constant communication with sites, TPA, and EH&S regarding the claim to ensure accuracy in recordkeeping.
- Communicate and Develop WorkCare Protocols for all sites
- Ensure that each site is fully implementing
- WorkCare cards, stickers and posters have been sent to all sites
- Intake forms have been completed by site and returned to WorkCare
- Occupational clinics chosen by sites are approved
- Ensure each site is properly trained on the WorkCare process and expectations
- Monthly updates and changes to contacts have been communicated to WorkCare
- Trackutilizationof WorkCare use by site
- Report monthly metrics of use to VP EH&S (report to include)
- Number of calls to WorkCare including those that remained first aid and those that became recordable
- Number and locations of sites that did not use WorkCare and whether that case became recordable and why
- Manage claims process to ensure cost mitigation and timely closure including claims reviews that focus on file outcomes; settlement analysis and extension of authority in conjunction with the insurer and/or in accordance with state statute and rules; and subrogation direction and analysis that is in accordance with the overall insurance program and litigation management.
- Develop and recommend WC program changes to the EH&S Program Manager that strengthen program goals and mitigate costs
- Develop quality assurance program for TPA and vendors to ensure UTAS overall goals are met
- Actively participate as a member of the UTC WC Council
- Assist the EH&S Program Manager in setting goals, creating and providing additional staff and vendor training as directed (not limited to)
- Ensure that each site is provided with the appropriate level of medical.
- Determine if on-site nurses are required.
- Ensure that Standard Orders are completed and up to date.
- Ensure Occupational Health Clinics understand and follow approved protocols and review at least annually.
- Standardize medical clinic protocols and documents
- Collaborate with HR/Legal to create GINA document for all sites post offer physical
- Engage WorkCare physicians in research and training/conferences
- Establish protocols for essential job functions as part of onboarding process and hiring.
- Assist sites with medical surveillance concerns from both medical and EHS regulations
- 7 years minimum experience in Occupational and Environmental Health
- 7 years knowledge of medical terminology, occupational injuries, and medical treatment protocols.
- 7 years Program development, leadership and management skills
- 7 years experience and knowledge of workers’ compensation, regulatory compliance and standards of care (OSHA, AAOHN)
- 7 years Microsoft office skills with Word, Excel and PowerPoint
- Active license in field of practice as appropriate
- Certification in Occupational Health (COHN OR COHN-S) as appropriate
- Certification in Case Management (CCM) if possible
- Strong interpersonal skills with strong oral presentation and written communication skills
- Able to sit, stand, and walk for extended periods of time
- Able to travel by car or plane for extended periods of time
Education: Required Education:
Bachelor Degree in medical field and/or 7 years minimum experience in Occupational and Environmental Health
Master's Degree in a related field at least 5 years’ experience working with workers compensation claims management.