Workers Comp Specialist

3 weeks ago

Ventura, United States Community Memorial Healthcare Full time

Compensation:
**_ Salary Range: $32.01 - $44.56 / hour_**

**Responsibilities**:
Reports to the Director of Occupational Health Services and is responsible for providing Workers’ Compensation/disability and Loss prevention activities for Community Memorial Health System and its affiliates. Acts as a resource to the CMHS leadership team and employees regarding workers compensation. Coordinates activities between employees, supervisors, medical providers, third party administrators, legal counsel, Human Resources, Payroll and other agencies involved with leave of absences and California Workers Compensation. Assist with minimize the risk of job-related accidents and monitor operations to eliminate hazardous activities. Promote Occupational Health and Workers’ Compensation safety awareness. Performs general administrative and office support duties on assigned projects and other work as necessary.

**Essential Functions and Responsibilities**:

- Acts as a resource to the CMHS, leadership team, and employees regarding workers compensation guidelines, policies, and processes.
- Identifies workers compensation claims requiring additional attention/escalation and initiates interventions to properly address the circumstances of the claim.
- Provides proactive communication/education with managers and employees regarding workers compensation to include education on state and federal workers compensation legislation and policy interpretation.
- Corresponds in a timely manner via telephone or electronically to supervisors, employees, physicians, medical clinics, investigators, legal counsel, and the third party administrator regarding workers compensation claims.
- Prepares correspondence to be sent to employees as applicable and in accordance with policies.
- Submits workers compensation and disability claims to the third part administrator within 3 business days and reviews them for completeness.
- Utilizes a medical claims management approach with the guidance of the Occupational Health clinical team to coordinate medical treatment, return to work, and leave of absences related to worker’s compensation.
- Provides assistance and instruction to managers and supervisors regarding workers compensation leave of absence electronic tracking system.
- Escalates difficult or sensitive medical industrial and non-industrial employment related issues to Human Resources and Occupational Health RN.
- Ensures paid leaves, long term sick banks and transitional work banks are appropriately accessed. Assists employees with questions regarding workers compensation benefits and coordination of payroll benefits.
- Maintains and edits payroll records for employees on workers compensation. Assure appropriate payroll information is communicated to the third party administrator and supervisors to establish appropriate payment of benefits.
- Processes employee terminations, ensures checks are timely and processes additional termination documents as necessary
- Performs related clerical duties such as filing, photocopying, and running errands as required to maintain department operations.
- Participates in Occupational Health annual programs.
- Facilitates workers compensation leave of absence approvals, return to work, transitional work, and job accommodation.
- Ensures proper documentation has been completed by the employee, Human Resources Department, and Occupational Health and ensures electronic documentation systems are updated with appropriate statuses.
- Keep records of work safety-related incidents and propose corrective actions.
- Collaborate with managers to monitor compliance and identify safety issues.
- Performs duties as assigned.

Qualifications:
**Required**:

- High School diploma or equivalent (GED)
- Five (5) years’ experience in Workers’ Compensation Claims Management
- Knowledge of State and Federal labor laws and regulations
- Three (3) years’ experience in Human Resources or Occupational Health in an acute health care environment within the last five years
- Proficiency in Microsoft Word, Excel, Power Point and Outlook
- One (1) year experience in a medical or business office
- Bilingual (English/Spanish)

**Preferred**:

- Bachelor’s Degree in Business Administration
- Ten (10) years’ experience in Workers’ Compensation Claims Management
- Five (5) years’ experience in Human Resources or Occupational Health

Overview:
**When it comes to quality, we're 5 Star**

Community Memorial Health System was established in 2005 when Community Memorial Hospital in Ventura merged with Ojai Valley Community Hospital. It is comprised of these two hospitals along with a network of primary and specialty care health centers serving various communities across west Ventura County. Our health system is a community-owned, not-for-profit organization. As such, we are not backed by a corporate or government entity, nor do we answer to shareholders. We depend on - and answer to - the communities we serve.

Community Mem

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