Job Title: Workers Compensation Claims Coordinator
Department: Human Resources
Reports To: Sr. Human Resources Director
Date of Opening: Immediately
Location: Salinas, CA
Our Company: We are an established Company with operations in Brawley, Coachella, Salinas Valley, Newman and Santa Rosa California, and Yuma, Arizona. We pride ourselves with providing agricultural labor, custom harvesting, and operational support to our customers with an emphasis of enhancing value to our farmers’ all while maintaining safety, quality, and innovation in mind. Our team is incredibly dedicated, pioneering, abides by integrity and is our number one asset.
Your Role: Under general direction, ensures timely processing of workers' compensation claims; evaluates accident reports to determine accuracy and completeness and to ensure adequate investigation; ensures that the city is in compliance with applicable laws and regulations; provides training and guidance to claims coordinators in all departments.
Supervisory Responsibilities:
- This position has no direct supervisory responsibilities but does serve as a coach and mentor for other positions in the company.
_ Duties/Responsibilities:_
· Ensures proper and timely follow up with employee, manager and TPA regarding workers’ compensation claims.
· Collects and maintains WC claim information, employee fit-for-duty exams; tracks lost time and light duty hours.
· Coordinates and schedules medical evaluations
· Enters all WC claim information into the TPA software; prepares and maintains WC files.
· Serves as a liaison for the TPA to answer questions and provide information to injured employees and supervisors related to claim processing, wages, medical bills, invoices, and the status of claims.
· Assists in the coordination, and implementation of workers’ compensation policies, procedures, forms, and methods of proper recordkeeping and provides guidance to Managers.
· Assists in the preparation of workers’ compensation data regarding incident summary, patterns, opportunities to mitigate risk and special reports, correspondence, and other written materials.
· Communicates verbally and in writing on non-routine matters which involve interpretation of policy; assists in the development of presentations and training to communicate workers’ compensation policies and procedures.
- Evaluates accident reports, ensuring the timely processing of medical bills and temporary total disability benefits; reviews medical reports, witness statements, department investigation results and other documentation. Compiles facts and data regarding accident reports and filed cases.
- Maintains subrogation records and files for those incidents involving third parties; sends subrogation letters to third parties in an effort to obtain reimbursement of monies spent by the city for medical treatment, time loss, and awards and settlements paid; submits amounts paid for medical treatment and/or temporary total disability benefits to the State Attorney's Office in order to seek reimbursement in cases where criminal charges have been filed.
- Reviews documentation to determine whether medical bills and temporary total disability benefits should be continued; authorizes payment of medical bills and temporary total disability benefits upon receipt of proper documentation. Advises and/or assists departments in conducting investigation of accident reports, including interviewing of witnesses and procurement of relevant documentation.
- Reviews accident reports to identify patterns of injury and to determine whether unsafe conditions contributed to the accident; advises departments of trends in injuries and proper safety procedures that may result in reduction of injuries; provides department with information that will aid in reducing accidents and improve safety.
- Trains Field Safety Coordinators, Managers, Supervisors and Foremen’s in the proper procedures and forms to be utilized in the preparation of accident reports, notices of absence, and notices of return to work in accordance with policies and the Workers' Compensation procedures.
- Documents telephone conversations, witness statements, medical reports, accident investigation results and payment of medical bills; prepares summaries of medical reports; ensures that Illinois Industrial Commission forms are properly prepared and filed.
- Attends seminars, conducts research and maintains liaison with individuals in the medical community and health care fields to keep abreast of current medical procedures and medications.
- Develop efficient processes to meet organizational objectives for Workers Compensation department.
- Performs other related duties as assigned.
Required Skills/Abilities:
- Working knowledge of the Workers' Compensation Act and other applicable state/federal statutes and regulations.
- Working knowledge of medical terminology, body systems and/or impairments and their disabling effects.
- Ability to obtain facts that ensure that claims information is complete and accurate.
- Ability to balance casework loads and efficiently process claims.
- Ability to evaluate all medical and time-loss claims information to make determinations regarding payment of temporary total disability benefits and medical bills.
- Good judgment in interpreting medical facts presented by a physician and applying these facts in determining an individual's capacity to engage in gainful occupation.
- Ability to read, assimilate and recall with marked proficiency facts, figures and descriptions, and to search for and obtain information.
- Ability to maintain satisfactory working relationships with co-workers, the general public and other agency personnel.
- Excellent effective verbal and written communication skills.
- Excellent interpersonal and customer service skills.
- Excellent organizational skills and attention to detail.
- Ability to comprehend, interpret, and apply the appropriate sections of applicable laws, guidelines, regulations, ordinances, and policies.
- Ability to acquire a thorough understanding of the organization's hierarchy, jobs, qualifications, compensation practices, and the administrative practices related to those factors.
- Excellent time management skills with a proven ability to meet deadlines.
- Strong analytical and problem-solving skills.
- Proficient with Microsoft Office Suite or related software.
Education and Experience:
- Requires knowledge, skill and mental development equivalent to the completion of 4 years of college with courses in medical terminology or anatomy and 3 years of experience in medical claims analysis or any equivalent combination of training and experience.
Your Language Skills
- Must have the ability to communicate effectively and a professional manner with all Company employees, including general labor, administrative, supervisory and management employees and external stakeholders.
- Must be bilingual and biliterate in English and Spanish.
Your Mathematical Skills
- Must have the ability to add, subtract, multiply, and divide; apply concepts of basic algebra; and interpret graphs, charts, and tables.
Other
- Requires working outside normal business hours and weekends.
- Requires some travel to different company worksites including field site visits and Yuma and Salinas Operations.
Physical Requirements and Work Environment
- Prolonged periods of sitting at a desk and working on a computer.
- Light to moderate lifting (up to 25 pounds).
- Reaching, stooping, pulling, pushing and manual dexterity.
- Operating a computer, calculator, copier, and typewriter involves repetitive hand arm movement.
- Must be able to visit all Company departments and environments, including, office, field, shop, etc.
- Entering data by touch requires the ability to hear computer alarms for errors.
- Must be able to handle multi-tasks and work in a fast-paced environment with frequent interruptions.
- Must be able to interact politely with outside customers and vendors.
- Communication with other staff members involves making contact orally, via the telephone, electronic email or in person.
EOE
Job Type: Full-time
Pay: $68,000.00 - $78,000.00 per year
Benefits:
- 401(k)
- 401(k) matching
- Dental insurance
- Health insurance
- Life insurance
- Paid time off
- Vision insurance
Schedule:
- 10 hour shift
- 8 hour shift
- Monday to Friday
- Weekends as needed
Work setting:
Experience:
- Microsoft Office: 1 year (Preferred)
- Customer service: 3 years (Preferred)
- Medical Claims: 3 years (Required)
- Workers Compensation Claims: 3 years (Required)
Work Location: In person