Workers' Compensation Specialist

1 month ago

santa fe springs, United States myTOD, LLC Full time

The Workers' Compensation Specialist position is expected to manage work-related accidents and facilitate the smooth transition of employees back into the workplace following a work-related accident. They will analyze trends, communicate, and strategize with various departments to provide a proactive approach to address underlying issues contributing to workplace injuries while ensuring compliance with relevant laws and requirements.


Essential Job Functions


  • Manage all aspects of the workers' compensation process, including initial claims, ongoing case management, and interfaces with legal on final settlements.
  • Ensures timely processing of workers' compensation claims; evaluates accident reports to determine accuracy and completeness and to ensure adequate scope of investigation for human resources and safety departments.
  • Ensure compliance with state and federal regulations related to workers' compensation.
  • Oversees the management of employee injury cases, and investigates claims.
  • Develops, implements, and monitors workers' compensation claims reporting forms, procedures, training, and other related activities.
  • Responsible for performing risk assessments, monitoring litigation status on elevated claim files, and providing recommendations for loss mitigation.
  • Attends depositions and hearings of litigated claims as needed.
  • Participates in annual and mid-term claim reviews with broker and carrier representatives.
  • Analyze safety metrics to provide leadership with accurate reporting and metrics to support business safety initiatives and justify allocating appropriate resources to areas where the safety risk is highest to reduce WC claims.
  • Lead cross-functional teams to conduct risk assessments to proactively identify potential risks that could contribute to injuries or compliance issues and develop action plans to address them.
  • Collaborate with HR and other departments to develop and implement “tools” to assist with WC initiatives, and create and maintain policies and procedures related to workers' compensation.
  • Track upcoming regulatory changes and identify the impact on the company's operation then process necessary adjustments to current practices.
  • Serves as subject matter expert for employees and management regarding workers' compensation policies and procedures.
  • Conduct regular training and education sessions with all associated departments to ensure understanding of the Worker's Compensation process, company policies & procedures.
  • Manages relationship with Third Party Administrator to accurately document lost time for OSHA reporting.
  • Audit claims to ensure insurance carrier is delivering quality support to injured employees; provide feedback to senior HR management where deficiencies or issues are identified.
  • Review and evaluate return-to-work data and results, providing feedback to operations on outcomes, trends, and recommendations for improvement.
  • Provides and maintains accurate records of claims and works with benefits team to manage leaves of absence related to workers' compensation claims.
  • This position may also be assigned other various Human Resources related duties.


Experience/ Training/ Education


  • 5 of years of experience in Occupational Health & Safety, Workers’ Compensation Claims, or in a Corporate Workers’ Compensation environment.
  • Prior experience demonstrating a high level of organization, follow-up, and accountability
  • Must be experienced with FMLA, ADA, FEHA, LOA, and California leave laws.
  • HRIS Experience required, preferably with Dayforce.
  • Minimum 4 Year / Bachelors Degree years of experience in human resource practices or worker's compensation field, or equivalent relevant experience


Knowledge, Skills, and Ability


  • Strong knowledge of California Worker's Compensation operations.
  • Working knowledge of the nature and extent of injuries, periods of disability, and treatment needed.
  • Working knowledge of functional job analysis, employment regulations, and workers' compensation laws as it relate to FMLA, STD, LTD, and ADA.
  • Demonstrates a thorough working knowledge of claim processing and claim policies and procedures.
  • Proactively identifies current or future problems/opportunities; analyzes and compares information to understand issues; identifies cause/effect relationships; and explores alternative solutions that support sound decision-making.
  • Must have investigative skills including the ability to take statements. Follows a logical sequence of inquiry with the goal of arriving at an accurate reconstruction of events related to the loss.
  • Expresses, summarizes, and records thoughts clearly and concisely orally and in writing by applying proper content, format, sentence structure, grammar, language, and terminology.
  • Good computer skills, including Microsoft Office Suite.
  • Analytical and problem-solving skills.
  • Ability to use discretion when handling confidential information.
  • Ability to effectively present case resolution to internal and/ or external stakeholders.
  • Critical thinking, attention to detail, excellent time management, the ability to work both independently and in a team setting, and superior customer service skills are fundamental to success.
  • Ability to handle most issues and problems and refer more complex issues to the manager and/or legal team.
  • Ability to identify and seek needed information/possesses thorough research skills.
  • Ability to effectively manage multiple priorities, changing deadlines, and frequent interruptions
  • Ability to build strong working relationships and communicate with employees across all levels of the organization.
  • Ability to establish a plan/course of action and contingencies for self or others to meet current or future goals.

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