MINIMUM QUALIFICATIONS:
EDUCATION, CERTIFICATION, EXPERIENCE AND/OR LICENSURE:
1. Bachelor’s degree in Business, Human Resources, Risk Management, Accounting or related, or in a medical, rehabilitation or similar health education field AND one (1) year of experience in workers compensation, claims management, risk management, legal, benefits administration, human resources, or a related field.
2.Valid Driver’s License throughout employment.
PREFERRED QUALIFICATIONS:
EXPERIENCE:
1. Familiarity with medical and statutory terminology common in workers’ compensation and musculoskeletal injuries.
2 Experience with management of occupational illnesses and injuries, workers' compensation and/or OSHA.
CORE DUTIES AND RESPONSIBILITIES: The statements described here are intended to describe the general nature of work being performed by people assigned to this position. They are not intended to be constructed as an all-inclusive list of all responsibilities and duties. Other duties may be assigned.
1. Assists Administrator with staff training on workers’ compensation policies, incident reporting requirements, and employee/manager responsibilities during the WC process.
2. Reviews and/or complete the employer-required elements of claims processing with the insurance carrier or third-party administrator, to include wage information necessary for carrier calculation of benefits.
3. Oversees the case management of employees’ claims and interact with carrier and/or third-party administrator staff to ensure proactive management of claims.
4. When necessary, assists the carrier with expediting treatment for employees; Works with the carrier to ensure communication with the physician, nurse case manager, claim adjuster and supervisor is provided promptly.
5. Reviews carrier adjuster’s case files, letter and other communication to assist/update claim action plans; including identification and modification of suitable restrictions for transitional duty.
6. Directs employee inquires on claims to appropriate carrier’s claims manager. When necessary, responds to employee inquiries about claim issues and questions, assist the carrier in resolving concerns and explain benefits.
7. Assists Administrator with establishing relationships and education with physicians and clinics to make them aware of the RTW program and transitional-duty assignments.
8. Screens claims for evidence of fraud, exaggeration and questionable compensability and communicate concerns to the carrier.
9. Assists in coordination with loss control, and risk management personnel to implement corrective measures and decrease possibility of repeat accidents.
10. Assesses level of medical treatment to determine if meets recordable criteria for Osha recordable and reportable criteria. Provides system support for Safety and HR on Osha reporting.
11. Maintains required Osha data fields for dates of injury, description of injury, employee demographics, injury type, restricted days, off work, and return to work date, etc.
12. Maintains Osha logs for all system facilities
Provides assistance to safety or facility representative regarding details on what they will post on logs.
13. Assists in data analytics and build of Tableau platform for work-related injuries.
14. Engages in post-injury absence management tracking, including support for ADA Specialist, Leave of Absence team, HR team, and Legal team to assess interplay between absences and available benefits. Coordinates with legal, managers, HR, ADA, LOA team for job transfers and terminations. Assists in discussion of terminations and interplay with a workers’ comp claim. Participates in discussions of settlement negotiations and attends legal hearings.
PHYSICAL REQUIREMENTS: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
1. Manual dexterity used in operating standard equipment; Prolonged periods of sitting.
2. Ability to drive
3. May be required to walk to various areas throughout the department or medical complex. This may require use of elevators and/or stairs.
WORKING ENVIRONMENT: The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
1. Standard office environment.
2. Periodic driving and travel to various WVU Medicine hospitals and clinics across West Virginia and surrounding states
SKILLS AND ABILITIES:
1. Basic computer knowledge and ability to operate standard office software
2. Prior experience with Microsoft Office Suite software applications, including but not limited to, Word, Excel, Access, PowerPoint, and Outlook
3. Knowledge of medical terminology and workers’ compensation terminology
4. Good verbal, mathematical, writing and presentation skills preferred
5. Previous experience with West Virginia workers’ compensation claims.
Additional Job Description:
Scheduled Weekly Hours:
40Shift:
Exempt/Non-Exempt:
United States of America (Non-Exempt)Company:
SYSTEM West Virginia University Health SystemCost Center:
634 SYSTEM Risk Management
Sopra HR Software
D2L
Softgic
Catawiki
