JOB PURPOSE: Provides oversight of ill or injured partners and works with physicians, place of employment, and insurance company to coordinate a return to work by providing efficient, cost effective, quality claims management services for workers’ compensation injuries/claims.
KEY RESPONSIBILITIES: • Gathers the information necessary to evaluate the workers compensation claims. This requires telephonic or written contacts with: Attending physicians and other health care professionals, Hospitals, rehab and nursing facilities, Attorneys, Vocational rehabilitation specialists, such as counselors, instructors, work evaluators, job placement specialists and social workers, Public and private rehabilitation agencies, and Insurance Company Claim Representatives. • Identifies and analyzes all factors contributing to the Injured Worker’s disability. • Develops and implements return to work plans to maximize healthcare outcomes and facilitate aggressive return to work • Communicates solutions effectively with return to work plans, through cooperation with injured workers, Claim Representatives, Physicians, Rehabilitation service providers, Employers, Attorneys, and Regulatory Agencies. • Works with Director of Workers’ Compensation and partner safety to develop transitional Duty programs and to improve use of ergonomics in the workplace. • Works with PruittHealth locations to implement return to work programs.
MINIMUM EDUCATION REQUIRED: • Bachelor’s degree in a health-related field or claims related field • 5-10 years workers compensation experience.
MINIMUM LICENSURE/CERTIFICATION REQUIRED BY LAW: • Georgia workers compensation license.
ADDITIONAL QUALIFICATIONS: (Preferred qualifications) • Working knowledge of industry trends, developments, current standards and regulations • Professional level knowledge of medical terms, practices and procedures. • Maintains confidentiality; demonstrates professional conduct and dependability. • Excellent written and verbal communication skills. • Experienced presenting appropriately designed return to work plans through cooperation with Injured Workers, Claim Representatives. • Thorough knowledge of general insurance principles, coverage’s and the workers’ compensation law. Understands and able to differentiate between various types of coverage’s and the contractual obligations of each. Coordinates the provision of physical and vocational rehabilitation services to disabled claimants within the framework of the company’s contractual and legal obligations. • Must maintain professional license and certification in active and current status. • Persons who have been found guilty by a court of law of abusing, neglecting or mistreating individuals in a heath care related setting are ineligible for employment in this position.