Workers Compensation Manager (Senior Level)

As a member of our internal Health & Safety team, utilize your knowledge of Workers Compensation to independently investigate, evaluate and resolve assigned claims of a more complex nature in order to achieve appropriate outcomes.

In this position you will administer and resolve high risk claims in a timely manner in accordance with legal statues, policy provisions, and company guidelines.

Works independently and may collaborate with subject-matter-experts (SMEs) as needed.

Empowered to progress claims through vendor management and influence others involved with claims processing.

RESPONSIBILITIES:


* Manage Workers' Compensation Case intake, which may include:


* File incident reports and/or claims with TPA (Travelers) and accurately document investigations to ensure faster settlements and resolution (HR to H&S).


* Connect employees to WorkCare (when necessary).


* Transfer information from Event Communication System (ECS) to WC TPA (Travelers) as necessary.


* Work with North America (NA) H&S team, employee line managers, and project managers to gather additional case information as needed.


* Protect personal information needed by vendor for processing claim as data is entered upon intake (HR).


* Facilitate safe and timely return to work, which may include:


* Liaise with employees, line managers, project managers, North America (NA) H&S team, insurance representatives, medical staff and attorneys involved with a case.


* Ensure clarity regarding work restrictions for every workers’ compensation case by consulting with medical treatment providers and HRBP's.


* Participate in Integrated Disability Committee (IDC), which may include:


* Monitor Experience Modification Rating (EMR) and work to reduce liabilities with the goal of achieving an EMR under 1.0.


* Review, monitor, and evaluate current claims and claim status.


* Work with leadership and vendor partners to determine potential claim settlement recommendations (must be approved through legal).


* Communicate case status details and necessary information to involved parties.

This may include notifications of hearings, outcomes, return to work status, or restrictions.


* Prepare coverage analysis and reporting for leadership.


* Report potential fraud that affects critical claim decisions, suggest Independent Medical Examinations (IMEs) or surveillance in questionable areas, and ensure corporate risk is aware and tracking subrogation opportunities.


* Suggest more timely actioning or follow up when medical visits don't appear timely.


* Maintain subrogation records for workers compensation claims.


* Program implementation, which may include:
+ Implement a consistent process for recording, investigating, and reporting workers' compensation claims complying with laws and regulations.
+ Educate employees about workers' compensation procedures and policies.


* Evaluate insurance coding...