The Workers Compensation Specialist is responsible for overseeing the medical clinic staff and for managing all Workers’ Compensation claims utilizing the Smithfield Workers’ Compensation Claims Management Program. The WC Specialist (WCS) is required to act as an advocate and claims specialist providing initial and on-going advocacy of claims including detailed analysis, ensuring thorough investigation. In addition, the WCS coordinates all return to work efforts, helps coordinate transitional duty job offers, maintains the location’s Transitional Duty Job Task Bank, coordinates and leads roundtable discussions of open claims, attends claims review meetings, and maintains general oversight of the claim to ensure the TPA is effectively moving the claim toward resolution.
The candidate must possess a desire to develop technical knowledge of standard concepts, practices, procedures, laws and regulations within Workers Compensation and related services. They review, recommend and assist adjusters in investigation strategies. Core Responsibilities
- Reports all new claims to TPA via Claim Intake platform, either entering the claims directly or working with in-house clinic to complete this task.
- Meets with all injured employees on new claims to explain the WC process, present them with the WC Packet, Health Access Card and First Fill card
- For new claims, works within California law to direct the initial medical care
- Work closely with TPA adjuster on every claim to make sure adjuster has clear knowledge and understanding of all facts of each claim
- Participates in claim reviews, and hearings, as appropriate. Reviews workers’ compensation costs and monitor claims to help reduce workers’ compensation costs.
- Serves as liaison with insurance TPA, health provider and company.
- Completes the entire California Self-insured Reporting process for all California locations
- Responsible for monitoring and oversight of patient care including doctors’ visits, therapy sessions and return to work.
- Facilitates the entire temporary transitional duty process in keeping with Smithfield guidelines, recognizing and pursuing alternative transitional duty assignments whenever possible, working closely with TPA to coordinate these efforts.
- Develops and coordinates return to work plans including job assessments. Works closely with local HR department, so they maintain compliance with the Americans with Disability Act (ADA) and Family Medical Leave Act (FMLA).
- Reviews medical reports and works collaboratively with adjuster to evaluate employee’s work restrictions; ability to return to work and or need for reasonable accommodation on short and long-term basis.
- Meets with employees face to face to discuss temporary or permanent work restrictions to assist them in returning to work in safe and durable manner.
- Initiates incident investigation report, secure employee and witness statements and send to TPA
- Ensures supervisory personnel are aware of employee restrictions due to work related injury or illness. Ensures employees are working within those restrictions. Keeps organized Workers’ Compensation file for each claim.
Act as communication liaison between the various departments:
- Communicate to upper management on a weekly basis status of all open claims. Open communication with Human Resources on denied claims and lost time claims.
- Participate in new employee orientation to ensure employees are aware of proper work-related reporting procedures. Ensure management team has clear understanding of the Return to Work portion of the program. Assist with annual Workers’ Compensation supervisory training.
The above statements are intended to describe the general nature of work being performed. They are not intended to be an exhaustive list of all required responsibilities, duties, and skills. May perform other duties as assigned.Qualifications
The requirements listed below are representative of the knowledge, skills, and/or ability required. Reasonable accommodations may be made to enable individuals to perform the essential functions.
Work Environment & Physical Demands
- Bachelor’s Degree and 5+ years related experience in Workers Compensation claim management; or equivalent combination of education and experience are required.
- Expert level knowledge of California Workers’ Compensation laws. Have working knowledge of OSHA, ADA, FMLA and HIPPA regulations.
- Possession of a certificate in Workers’ Compensation from an institution recognized by the California Department of Insurance or the Insurance Education Association is highly desired.
- Self-Insurance Professional Certification Preferred
- Must be able to collaborate with other functional areas such as Human Resources, Safety and the Management/supervisory team.
- Bilingual, English-Spanish, preferred.
- Ability to work well with others in fast paced, dynamic environment.
- Ability to be respectful, approachable and team oriented while building strong working relationships and a positive work environment.
The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
- The majority of the time is spent in an office setting outside of the production plant. The plant environment will include wet or humid conditions (non-weather related), extreme cold and heat (non-weather related), working near moving mechanical parts, exposure to fumes or airborne particles, and chemicals.
- Noise level in the work environment is usually moderate but can be loud when in the production area.
Smithfield, is an equal opportunity employer committed to workplace diversity. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, sexual orientation, national origin, age, gender identity, protected veterans status or status as a disabled individual or any other protected group status or non-job related characteristic as directed by law.Careers and Benefits
To learn more about Smithfield’s benefits, visit smithfieldfoods.com/careerbenefits