Workers Compensation Specialist
Vidant Health - Greenville, NC

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Responsibilities
1. Reviews and determines Workers Compensation (WC) claim reportability per Employee Event Reports in accordance with the Workers Compensation Act and the North Carolina Industrial Commission (NCIC), working closely with the assigned adjustor.
  • Determines a report of injury to be a manageable in-house claim or generates the Employers Report of Injury (Form 19) which is filed with the adjustor for additional processing per NCIC regulations for injuries resulting in lost time or medical expenses that exceed $2000.00.
  • Establishes a case file with documentation entered to established reports, databases and spreadsheets for case progress, lost time tracking and expenditures.
  • Initiates Form 28 and 28T as needed based on the employees status to capture timeframes of absence or reduced earning capacity due to medically imposed restrictions so that non-paid waiting periods are established and supplemental wage payments are initiated through the insurance adjuster in a timely manner.
  • Reviews all case notes and maintains an ongoing report of each open claim to provide an at-a-glance narrative of the case history. Key elements include the monitoring of employees in out of work / restricted work status, legal status of those with/without attorneys having taken more formal action with their claims and settlement history.
  • Manages and approves the Limited Duty Program (LDP) payroll, providing support and instruction to the employee (and acting supervisor in some cases) regarding the program, time off, chain of command, payroll and WC supplemental pay, etc.
  • Generates instructional e-mail as needed to managers regarding their employees placed in an out of work or reduced hour schedule with specific regard to payroll so that overpayments are not made in the event an employee is eligible to receive WC pay supplements.
  • Generates Personnel Action Forms (PAF) for all employees covered under WC and who are out of work 14 days or more as well as the return to work PAF to ensure that employees are placed in non-accrue status with regard to their benefit time.
  • Calculates and reports wages earned to insurance adjuster; care must be taken to factor wages at varying rates (LDP), calculating overtime, ensuring non-approved and/or approved absences are appropriately accounted for, etc.
  • Note: Position requires proficiency in the following software to accomplish all of the tasks described in this composite:
PeopleSoft, Kronos, Word, GroupWise, RiskMaster, Excel and Access
2. Reviews and determines work related employee injury reports for record ability in accordance with the US Department of Labor Occupational Safety & Health Administration and maintains required records for Vidant Medical Center and other entities.
  • Requires a working knowledge of the OSHA regulatory standard in order to effectively review each event for relevant criteria with regard to record ability. Initiative must be taken to seek new information and updates via the DOL website
  • Determines if a report of work related injury is recordable on the OSHA Log in the event of death, days away from work, restricted work, medical care beyond first aid or loss of consciousness. A WC claim is not required to establish record ability.
  • Initiates entry and ongoing tracking of the employee's status on the Log until the employee is released and returns to full duty or their out of work or restricted work status reaches 180 calendar days, whichever comes first.
  • Maintains separate and required privacy logs so that files are easily cross-reference from the log to detailed records of the event.
  • Ensures Logs are maintained in an up-to-date status in accordance with DOL guidelines and that the Annual Summary
Report for each subsidiary are signed and posted in accordance with DOL standards and timelines.
  • Anticipates, prepares for and submits OSHA survey data on-line within the established timeframe as requested by OSHA
3. Supports claims database within RiskMaster initiating new workers' compensation claims as needed, manages and maintains up-to-date data and manages associated financial data for each.
  • Creates and tracks claims data by entering specific information throughout the life of the claim in order to efficiently monitor claim activity.
  • Creates and generates reports, routine and as needed, to provide summary case file data to management and medical staff.
  • Enters financial data for each claim, categorizing the expense into specific service provider classifications, and generates financial data for use by management and finance personnel in the completion of Dashboard reports.
  • Reviews all claims and financial data for accuracy, investigates questionable information and initiates corrective action as needed to maintain the integrity of all files and records
4. Works closely with the Administrator in the day to day administrative functions related to WC to include but not limited to monthly, quarterly and annual budget reports, reconciliation of disbursements to replenish self-funded account, statistics, legal documents of discovery, etc.
  • Prepares monthly WC Budget Summary report detailing all open claims, monthly disbursements, legal settlements, processing fees and savings achieved through in-house write off.
  • Consolidates entity report and prepares Regional Summary report.
  • Reconciles WC adjuster's monthly reimbursement statement for accuracy and advises Administrator of problem areas to be resolved or that the report is acceptable for payment.
  • Maintains separate records associated with high-end WC expenses such as legal settlements and surgical expenses so that budget expenditures are more easily justified.
  • Reviews WC adjusters Monthly Check Register for activity to ensure the absence of inappropriate activity; investigates discrepancies thoroughly.
  • Calculates monthly injury incident rates to obtain a measurable account of the success rate in reducing injuries throughout the organization as a result of education and awareness.
  • Utilizes the monthly Underwriters Report to generate statistical data that can be provided to management regarding the severity & frequency of claims and expenses incurred in conjunction with RiskMaster
5. Maintains a current knowledge base of a variety of computer software to organize and generate data in a variety of formats for WC, OSHA and finance.
  • Maintains and provide management a wide variety of statistics and data for WC claims, OSHA reportable injuries and financial data for review of injuries and claims, trends, cost containment and forecasting.
  • Utilizes RiskMaster, Excel and Access software to maintain, create and generate statistics and reports on a routine and as needed basis to assist in the review and tracking of claims activity data and aid in the validation of claims expenses and payments
6. Verifies payables related to pre-employment/annual screenings, blood exposures & WC claims through cross-reference research to validate services and directs bills through appropriate channels for payment
  • Receives and researches all employee related bills for the department and determines appropriate method of payment in the following manner: a) in-house write off; b) in-house budge adjustment; 3) payment to provider by Vidant Medical Center for outside & contract services; 4) forwarding to WC adjuster for payment and further processing.
  • Initiates follow-up as needed with medical records and/or providers to obtain additional information, correct inaccuracies, etc.
  • Maintains records that are easily retrieved in electronic and hard copy form for reference to review outstanding bills, inappropriate/misdirected bills, provider trends (ie, services provided in house vs. outside, types of treatment), etc.
  • Receives and verifies the monthly Pharmacy Statement for WC related prescriptions and initiates corrective action as needed. Verifies charges appearing on monthly Profit/Loss statement and acts on discrepancies.
7. Provides in-house education to managers and staff regarding WC related issues (general WC standards, Limited Duty Program, Payroll) and serves a resource to regional Occupational Health Nurses for WC and OSHA.
  • Provides employees with written documentation at the onset of their claim regarding their status if taken out of work or placed in an alternate assignment to prepare them for what may be a temporary financial loss. Will often meet one on one to discuss these details and provide examples of what their hospital pay will be and when to expect payments from
the insurance adjuster (if applicable), etc. to provide a clear understanding of the timelines and differences that will be taking place regarding their financial situation.
  • Provides education about WC in general and directions regarding proper timekeeping methods (generally in writing via email for future reference) to managers and timekeepers in all WC lost time or alternative work assignment cases to ensure that the employees are treated consistently throughout the system and are not overpaid to avoid retroactive corrections and recovery of funds.
  • Monitors affected employee records throughout their course of recovery and follows-up with managers and timekeepers as needed to reinforce the plan of action.
  • Screens questions from employees, OH staff and managers regarding WC guidelines, Kronos entry as well as payroll staff regarding the accuracy of other entries made in the Kronos system for verification.
  • Provides assistance to regional OH staff as needed for similar issues as needed.
8. Promotes guest relations skills through interaction with employees, medical staff and the general public.
  • Maintains exceptional customer relations at all times with a variety of staff and members of the general public practicing varying methods of presentation as required given the intended audience.
9. Participates on selected hospital committees.
  • Safety Sub-Committee
  • Medical Case Management Team
  • Other committees as deemed appropriate given knowledge, skills and abilities.
10. Performs other duties as assigned by the Administrator, Occupational Health.
Minimum Position Requirements
College Degree (4 yrs.) Business Administration, Human Resources, or Financial Services. Related Work Experience: More than 2 years but less than 3 years Progressively responsible administrative or office manager position with diverse & broad responsibilities ranging from accounting, payroll, human resources, AP/AR, budget, workers compensation and OSHA with a substantial role in managing large amounts of time sensitive data subject to a variety of deadlines An equivalent combination of education and experience may be substituted year per year working as a Claims Adjustor, OSHA/Personnel/Payroll Technician/Analyst, Office Manager /Administrator, Risk/Safety Technician or similar position which justifies the necessary skills, abilities and knowledge required for this position or one year of additional experience (as described above) may be substituted for one year of the required education with a maximum substitution of two years.

1 full - time vacancy.
It is the goal of Vidant Health and its entities to employ the most qualified individual who best matches the requirements for the vacant position.
Offers of employment are subject to successful completion of all pre-employment screenings, which may include an occupational health screening, criminal record check, education, reference, and licensure verification.
Vidant Health is an Equal Opportunity Employer. EOE/AA Applications for Vidant Health and its subsidiary corporate entities are accepted and employees are chosen for employment without regard to race, color, gender, religion, age, national origin, marital status, citizenship, veteran status, or disability.

Vidant Medical Center - 21 months ago - save job
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