Case Management, Certified Case Manager (CCM), Claims Management, Claims Processing, Cost Control, Customer Escalations, Employee Retention, Human Resources, Integrated Circuits (ICs), Legal, Litigation, Medical Treatment, Organizational Culture, Organizational Development/Management, People Management, Performance Reviews, Presentation/Verbal Skills, Process Management, Project/Program Coordination, Quality Management, Sales, Time Management, Treatment Plan, Utilization Management, Worker's Compensation
Primary objectives for the IC position are:
Serve as an advocate for all injured workers
Coordinate daily claim activities to reduce the cost of each claim from day one
Improve the quality of workers' compensation claim handling practices and ensure that this is consistent for all injuries
Coordinate the effective flow of claims information to all parties
The IC meets these objectives by working collaboratively with the injured employee, manager(s), human resources, physician(s), safety, and the claims adjuster. Immediate and ongoing contact with injured workers provides reassurances to the employee, answers questions, identifies concerns, sells the benefits of transitional duty and occupational physicians, and establishes the IC as a source of assistance in the workers' compensation process.
The IC's activities drive down both the human cost and the financial cost of workers' compensation claims by:
- Reducing unnecessary delays in the process
- Ensuring timely medical treatment
- Reducing lost time days through utilization of return-to-work
- Reducing the frequency of litigated claims
- Improving organizational culture and employee retention
Duties include:
- Initiate contact with injured employee immediately upon notification of injury and maintain communication throughout the life of the claim
- Serve as a sounding board for the injured worker and respond to questions about workers' compensation benefits
- Facilitate the resolution of claims by acting as liaison between the injured worker, adjusters and all other parties involved in the claim management process
- Ensure that medical treatment is provided as efficiently and effectively as possible to the injured worker
- Contact the treating physician following the injured employee's appointment to obtain diagnosis, work restrictions, and treatment plan
- Review employees' diagnosis and next steps with medical treatment, including diagnostic testing or specialist referral
- Facilitate transitional duty program and coordinate accommodation process
- Communicate with the claim adjuster, sharing information to ensure appropriate handling of each claim
- Demonstrate clear recognition of legal issues; ensure that they are elevated to the appropriate person based on the complexity of the situation
- Establish claim escalation criteria and escalate accordingly when criteria present
- Monitor claim for utilization of nurse case management and escalate accordingly
- Build and maintain effective relationships while learning and becoming a part of the organization's culture
- Exhibit a high level of competence and performance in written and verbal communications
- Communications should be timely, concise, and accurate
- Accurately document related information into claims management system
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