Interested candidates are invited to submit a cover letter and resume through the University of Michigan Careers website.
The Offices of Insurance & Claims Administration and Work Connections are seeking an experienced Absence/Leave Case Manager Senior to join our team. This position plays a critical role in the administration and management of occupational injury and illness claims by overseeing a caseload of lost time and medical-only workers' compensation claims. The Senior Case Manager serves as the primary point of contact for employees, supervisors, healthcare providers, and third-party administrators, ensuring timely claim management, coordination of medical care, regulatory compliance, and safe return-to-work planning.
The successful candidate will utilize proactive claim management strategies to promote employee recovery, minimize lost work time, control claim costs, and ensure compliance with University policies and the Michigan Workers' Disability Compensation Act. This position also serves as a resource to leadership and team members by providing expertise on complex workers' compensation and disability management issues.
Workers' Compensation Claim Management
- Manage a caseload of lost time and medical-only workers' compensation claims from initial report through claim resolution using proactive claim management strategies.
- Investigate claims to determine compensability and ensure compliance with applicable workers' compensation laws, University policies, and claim administration standards.
- Evaluate medical documentation, work restrictions, disability status, and treatment plans to develop effective claim management and return-to-work strategies.
- Coordinate medical treatment, independent medical evaluations, vocational services, and transitional work opportunities when appropriate.
- Analyze medical records, employment information, wage data, investigative findings, and claim trends to make informed claim management decisions.
- Establish and maintain appropriate claim reserves, authorize medical and indemnity payments, and monitor financial exposure throughout the life of the claim.
- Identify complex claims requiring additional intervention and collaborate with leadership, nurse case managers, legal counsel, and external partners to develop strategic action plans.
- Maintain accurate claim documentation, diary management, and timely follow-up activities in accordance with departmental service standards.
Customer Service
- Serve as the primary point of contact for employees, supervisors, healthcare providers, attorneys, and third-party administrators by providing timely guidance regarding workers' compensation benefits, claim status, and return-to-work expectations.
- Deliver exceptional customer service by maintaining confidentiality, setting clear expectations, and ensuring timely, accurate communication throughout the claim process.
- Develop collaborative working relationships with departments and employees to promote successful return-to-work outcomes and positive customer experiences.
- Resolve complex customer service issues by identifying barriers, coordinating stakeholders, and implementing effective solutions.
- Mentor and provide guidance to less experienced staff regarding claim management best practices, customer service, and regulatory compliance.
Reporting and Compliance
- Maintain accurate claim files, financial documentation, and regulatory reporting in accordance with University policies and state requirements.
- Prepare claim analysis, financial reports, reserve recommendations, and management reports as requested.
- Monitor claim activity to ensure compliance with departmental quality standards, internal audits, and regulatory requirements.
- Participate in departmental initiatives, quality assurance activities, and process improvement projects designed to improve operational efficiency and claim outcomes.
Collaboration and Return-to-Work
- Collaborate with employees, supervisors, healthcare providers, Occupational Health Services, Human Resources to coordinate appropriate medical care and return-to-work planning.
- Facilitate stakeholder meetings to address barriers impacting recovery, return to work, or claim resolution.
- Evaluate workplace restrictions and partner with departments to identify appropriate transitional work assignments and reasonable accommodations related to occupational injuries.
- Conduct worksite visits, when appropriate, to evaluate job demands and assist departments in developing effective return-to-work solutions.
- Build and maintain strong relationships with internal and external stakeholders to ensure consistent, high-quality workers' compensation and disability management services.
- Support team objectives by sharing knowledge, assisting colleagues, and contributing to a collaborative work environment.
- High school diploma or equivalent required; bachelor's degree in business, healthcare administration, human resources, insurance, nursing, or a related field is preferred.
- Three or more years of experience managing workers' compensation claims, including lost time and medical-only claims.
- Demonstrated knowledge of workers' compensation laws, disability management principles, and return-to-work practices.
- Strong analytical, problem-solving, negotiation, and decision-making skills.
- Excellent written and verbal communication skills with the ability to interact effectively with employees, healthcare providers, attorneys, and leadership.
- Ability to prioritize competing responsibilities, manage a high-volume caseload, and meet established deadlines.
- Ability to work independently while exercising sound judgment and collaborating effectively within a team environment.
- Proficiency with Microsoft Office Suite, Adobe Acrobat, Google Workspace, and electronic claims management systems.
- Commitment to providing exceptional customer service while maintaining confidentiality and professionalism.
- Knowledge and understanding of FMLA administration
- Experience in medical claims adjusting and/or other insurance related background.
- Experience and familiarity with claims risk management information systems
This position is eligible for a hybrid work arrangement at the discretion of the hiring department. Work agreements are reviewed annually and may be modified based on operational needs. Learn more about the University's work modes.
This is a full-time, exempt position, Monday through Friday. As part of the University of Michigan's Future of Work initiative, this role supports a hybrid work schedule that balances onsite and remote work while meeting operational and customer service needs.
The University of Michigan is an Equal Opportunity Employer. We are committed to providing an environment of mutual respect where equal employment opportunities are available to all applicants, including protected veterans and individuals with disabilities.
