Responsible for managing and monitoring Grange’s Workers’ Compensation program at our Home Office location as well as in our field offices. This includes developing and administering loss prevention and rehabilitation management and monitoring programs, maintaining files, and providing necessary support in defense of claims. Also responsible for developing successful partnerships between associates, third party administrators (TPAs), internal business partners and external service providers.
ESSENTIAL FUNCTIONS :
1. Acts as the point of notification and contact for associates and managers regarding any incident or injury that could or has resulted in a Workers’ Compensation claim. Ongoing point of contact to internal and external business partners for the duration of the claim.
2. Ensures compliance with state specific Workers’ Compensation regulations and Grange policies and guidelines. This includes acting as the point of contact and lead for audits and communicating the final outcome.
3. Point of contact for all documentation regarding incident. This includes internal notification and investigation details as well as any health information relevant to the claim from outside medical providers and treatment notes. Health information is limited to medical related to the injury.
4. Assess the medical and occupational needs of an injured associate via a combination of face to face, telephonic and written correspondence as needed.
5. Provide all relevant documentation regarding work related incidents to Benefits Administrator from a Leave of Absence (LOA) and FMLA perspective and TPA to assist in the determination of compensability and recording keeping requirements. This includes determining mechanism of injury, work restrictions, and managing the information related to work related injury/illness.
6. Communicate with providers, both internal and external to review treatment notes, ask for clarification when necessary, follow-up after initial appointments and ensure continuous communication with TPA.
7. Ensures confidentiality of Workers’ Compensation claims records; including relevant health information related to the claim.
8. Partner with multiple departments to coordinate and manage return to work options for associates to ensure that work restriction and transitional work guidelines are being adhered to.
9. Maintain consistent uniform records for each claim.
10. Regularly review all open claims for opportunities for claims management and partner with all relevant parties on a plan of action.
11. Assist Human Resources Business Partner team as needed. Assignments may include, but are not limited to, administrative tasks, recruiting support, reporting, researching vendors and other special projects.
MARGINAL FUNCTIONS :
1. Develop understanding of company benefits and assist in the communication of this information to all associates.
2. Participate in Human Resources activities and related organizations. May serve on a safety committee.
3. Perform special projects and other duties as needed.
Bachelors degree strongly desired, but can be replaced with equivalent education and experience. One to three years Workers’ Compensation experience required. Demonstrated knowledge of Workers’ Compensation claims management related laws and medical and legal terminology. Working knowledge of state specific Workers’ Compensation regulations. Strong interpersonal and communication skills, with ability to professionally communicate both verbally and written with associates and outside partners, recognizing and appropriately responding to others’ perspectives. Must be well organized, detailed oriented, and able to adjust to changing priorities. Must possess advanced computer skills, including Word, Excel and PowerPoint.
Grange Mutual Casualty Company - 21 months ago