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WORKERS COMPENSATION SPECIALIST SR - EMPLOYEE HEALTH SERVICES
Irvine, CA PRIMARY DUTIES AND RESPONSIBILITIES The Occupational Health Senior Workers' Compensation Specialist manages claims with external carriers and attorneys from employees first report of injury to resolution and is responsible for providing Workers' Compensation/disability and Loss prevention activities for **MEMBERS ONLY**SIGN UP NOW*** Hospital and its affiliates. Acts as a resource to the **MEMBERS ONLY**SIGN UP NOW*** leadership team and employees regarding workers compensation. Coordinates activities between employees, supervisors, medical providers, third party administrators, legal counsel, Human Resources, Payroll, EHS Medical Director, and other agencies involved with leave of absences and California Workers Compensation. Responsible for timely filing of Workers' Compensation claims. Creates and maintains correspondence and written information related to employee Workers' Compensation claims and leaves of absence. Maintains OSHA, injury, absence, modified/transitional duty, and other alternative electronic data methods. Performs general administrative and office support duties on assigned projects and other work as necessary. The Occupational Health Senior Workers' Compensation Specialist identifies claims requiring additional attention/escalation and initiates interventions to properly address the circumstances of the claim. Utilizes a medical claims management approach with the guidance of the Occupational Health clinical team to coordinate medical treatment, return to work, and leave of absences related to worker's compensation. Determines OSHA and workers compensation recordable/reportable incidents and reports the cases to the third-party administrator and regulatory agencies based on the determined severity of the incident. Maintains OHSA frequency, transitional work, lost workdays, and annual OSHA surveillance data and performs reporting functions to assist in complying with OHSA regulations and Hospital safety standards. Produces OSHA and workers compensation related data to the supervisors, leadership team, and the third-party administrator quarterly and ad hoc. Monitors workers' compensation leave of absences, transitional work, or alternative work assignments and reviews at designated and appropriate intervals. Escalates difficult or sensitive medical industrial and non-industrial employment related issues to Human Resources and Occupational Health RN. Works with the Payroll Department to ensure proper coordination of paid time off and sick pay. Ensures paid leaves, sick banks and transitional work banks are appropriately accessed. Assists employees with questions regarding workers compensation benefits and coordination of payroll benefits. Evaluates the appropriateness medical invoices generated by the workers compensation process. EDUCATION AND EXPERIENCE Bachelor's degree in related area and/or equivalent experience/training. 7 years progressive experience in HR, workers' compensation, risk management, disability case management, or relevant experience Two years of experience in hospital Employee Health, Occupational Health, Risk management, Human Resources or Infection Prevention Knowledge of employment laws including workers' compensation, leave of absence, reasonable accommodation, OSHA, and HIPAA CERTIFICATIONS REQUIRED BLS certificate CERTIFICATIONS PREFERRED Certified Worker's Compensation Case Manager Certified Professional in Disability Management (CDPM) Certified Occupational Health Nurse (COHN) Senior Professional in Human Resources (SPHR) |
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