Essential Functions:
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Oversees the full life cycle of workers’ compensation claim and develops strategies to handle specific cases in consultation with the appropriate parties.
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Enforces workers' compensation programs in alignment with department and company policies and procedures.
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Partners with other Human Resources teams on overlapping matters related individual cases involving LOA’s, employee relations, grievances, and performance management concerns with a goal of employee satisfaction and reducing our liability for litigation.
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Oversees workers compensation processes for medical treatments, benefits, and advocates for employees in resolving concerns and issues regarding their workers compensation claims.
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Interacts with employees while maintaining high level of customer service through follow up on work statuses and satisfaction of medical treatment, and their progress in modified duties; maintains dialogue with employees for up-to-date medical documentation and advocacy when needed to limit or avoid litigation, resulting in cost containment.
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Conducts employer level investigations to obtain critical information from witnesses, incident facts and evidence including company camera surveillance that help with the decision-making process of case facts and compensability
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Conducts return to work and interactive processes with injured employees, oversees outside disability management vendor on litigated cases.
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Completes and submits reportable injuries/illness and findings to third party administrator (TPA); relaying proposed actions to TPA for further handling.
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Partners with and supports TPA, legal counsel and injured workers on all open claims as necessary to ensure proper claim resolution.
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Diaries all open claims through resolution and maintains ongoing dialogue and provides direction on proceedings with legal, claims team and physicians to ensure best case outcomes at resolution.
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Attends Workers’ Compensation Appeal Board hearings, trials and depositions to represent the Company as necessary; provides pertinent case information to Defense Counsel as necessary.
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Responds to subpoenas, prepares case summaries for litigated claims, and partners with Defense Counsel and TPA to ensure clear understanding of case details and company disposition.
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Participates in quarterly claims review with TPA and legal counsel to discuss case updates and legal strategy towards cost effective and timely case resolution
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Identifies potential risk exposures and analyzes injury claims for potential risk trends to develop short and long-term resolution in partnership with appropriate parties to support mitigation of injuries and claims.
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Partners with Environmental Health & Safety (EHS) and Health and Wellness (H&W) to evaluate employee worksites and identify potential work injury job hazards including indication of safety, ergonomics, or additional risk trends. Discusses causes and concerns with EHS, H&W, and management to begin the correction and elimination of risk concerns.
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Participates in monthly risk management meetings with EHS and H&W to discuss identified risk and injury patterns and feasible action plan.
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Conducts up-to-date Workers’ Compensation training to new hires, current employees, and newly promoted members of leadership.
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Provides recommendations and implements improvements in injured worker and supervisor training.
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Partners with EHS on safety concerns identified and suspected from the employer level investigation, for assessment and correction. Supports EHS dept. with accident investigation and safety related assignments
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Helps with first aid treatment and First Responder assistance in emergency situations and for workers compensation related incidents.
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Supports all offsite locations with workplace injuries, training, protocols and provides annual regulatory insurance posting notices.
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Creates and maintains monthly injury and incident reports for management and HR Teams.
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Oversees compliance with internal policies, procedures, and workers compensation regulations; documents and maintains individual claim files and OSHA logs as required by Cal-OSHA.
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Attend and participate in professional group meetings; stay abreast of trends and innovations in the field of workers’ compensation administration and keep current on legislative and regulatory issues at the State and Federal level.
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Performs other related duties and projects as business needs require at direction of management.
Education and Experience:
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Bachelor’s degree in relevant field, a plus.
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Minimum Seven (7) years’ experience with worker’s compensation claims, system litigation process and exposure to large deductible programs; experience with disability management, Interactive Process and LOA’s.
Special Requirements/Certification:
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Workers’ Compensation Claims Administration (WCCA) certification, a plus.
Pay Range: $79,610-$100,000/yr
