Workers' Compensation Program Manager

Job Description

Job Description

WORKERS COMPENSATION PROGRAM MANAGER

Position specifications are intended to present a descriptive list of the range of duties performed by employees in the class. Specifications are not intended to reflect all duties performed within the job.

POSITION TITLE: Workers Compensation Program Manager

Reports to: Director-Claims Services

FLSA status: Non-Exempt

Salary range: Manager, $101,686-$136,269

Supervises the following direct reporting staff: as determined by future needs of Schools Insurance Group (the “Authority”)

POSITION SUMMARY

Under supervision of the Director-Claims Services, the Workers Compensation Program Manager oversees the Workers' Compensation Program for the SIG Workers Compensation Participating Districts. In addition, this position collaborates with SIG staff, member districts, injured employees, third-party administrators and other program stakeholders as it relates to communication with injured employees regarding the Workers' Compensation claims process and return to work, the medical provider network, and other cost mitigating resources. The primary goal of this position is the optimal Workers Compensation Program performance and cost efficiency.

ESSENTIAL DUTIES AND RESPONSIBILITIES - The following duties are typical for this manager-level position. Incumbents may not perform all of the listed duties and/or may be required to perform additional or different duties from those set forth below to address business needs, changing business practices, or expanded legal or regulatory compliance functions:

• In collaboration with other SIG staff, identifies, evaluates, implements and monitors programs, strategies, or actions to reduce employee injuries, facilitate return to work, and/or mitigate the cost of workers compensation claims;
• Assists with implementation and service to SIG Workers Compensation Participating; Districts in accordance with an advocacy based Workers Compensation claims model;
• Interacts with district representatives to facilitate the coordination of return-to-work assignments;
• Coordinates services with medical providers regarding disability and return-to-work assignments;
• Communicates with unrepresented injured employees to provide education regarding the Workers Compensation claims process, and specifically, to facilitate their healing and return to work;
• Plans and coordinates the daily operations of the Return-to-Work Program;
• Assists district representatives, the third-party administrator, defense counsel, consultants, and vendors to facilitate cost efficient claims settlement;
• Coordinates claim reviews and members and claims administrators on an ongoing basis;
• Maintains a data system for Workers' Compensation claims and case management;
• Compiles financial and statistical data;
• Uses current technology and equipment to generate spreadsheets, reports and correspondence;
• Conducts in-service training on an individual or group basis to staff in SIG Workers Compensation Participating Districts;
• Coordinates the medical control program with the appropriate clinics;
• Participates as a member of the Critical Claims Committee;
• Develops and maintains a process and procedures manual;
• Conducts a variety of complex research projects, compiling information, arriving at conclusions, and communicating results and recommendations to staff, SIG governing committees and/or the Joint Powers Board, as well as to SIG Participating Districts and their respective representatives;

· Perform related duties as assigned.

QUALIFICATION REQUIREMENTS - To perform this job successfully, an individual must be able to perform each of the essential duties satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Incumbents may not perform all of the listed duties (such as adjunct or non-essential duties) and/or may be required to perform additional or different duties from those set forth, to address newly established legislative or regulatory compliance requirements, business needs and changing business practices. Reasonable Accommodations may be made to enable individuals with disabilities to perform essential functions.

Knowledge of:

· Organizational and management practices as applied to the strategy, implementation, analysis and evaluation of programs, policies, and operational needs

· Principles, practices, and techniques necessary to establish, maintain and modify an advocacy-based Workers Compensation platform

· Workers Compensation program concepts

· Office procedures, methods, and equipment including computers and applicable software and social media applications.

· Business letter writing, report preparation and presentation formats

· Relevant (or applicable) compliance requirements in areas of federal and California compliance requirements for claims management and loss prevention programs and activities; including without limitation ADA, HIPAA, GINA, FEHA, CAL-GINA, OSHA and Cal-OSHA, as well as other statutory or regulatory mandates that apply to public school districts and county offices of education

· Relevant statutory and regulatory compliance requirements governing confidentiality and privacy requirements for employers and public entities, including recordkeeping

· FEHA laws and the Interactive Process

· Methods and practices of financial and statistical record keeping

· Computer applications including fluency in Excel and other programs used for statistical data management (data base, spreadsheets, word processing)

· Return-to-Work Program management and coordination

· Public speaking and presenting to groups

· Basic medical terms and procedures and treatment issues with Workers' Compensation clinicians

· Ability to discuss open Workers' Compensation claims with medical doctors, third party administrators, District staff, and injured employees.

· Maintain knowledge of Federal, State and local statute, case law and regulations pertaining to Workers Compensation

Ability and Skills to:

· Develop and administer strategies involving departmental goals, objectives and procedures, and supervise direct reporting staff as assigned in the execution of these strategic objectives.

· Direct, analyze and assess workers compensation program and operational needs and make appropriate adjustments.

· Organize and coordinate internal and external resources for implementing workers compensation program initiatives

· Analyze problems, identify alternative solutions, project consequences of proposed actions and implement recommendations in support of program goals.

· Prepare clear and concise administrative reports, including basic departmental budget projections.

· Interpret and apply applicable federal, state and local policies, laws and regulations.

· Communicate program expectations and compliance requirements to relevant personnel within member districts, claims administrators, medical providers, legal counsel, etc.

· Operate office equipment including computers and supporting software applications.

· Communicate clearly and concisely both orally and in writing and speak and present in public settings to large and small groups including conferences and training workshops.

· Establish and maintain effective and collaborative working relationships with those contacted in the course of work.

· Follow oral and written directions and specific rules, regulations and processes and apply them to a variety of situations.

Education and Experience - Any combination of education and experience that would likely provide the required knowledge and abilities is qualifying. A typical way to obtain the knowledge and abilities would be:

Education/Training :

A Bachelor’s degree from an accredited college or university with major course work in health management, nursing, insurance, business, or a related field is preferred. Any combination equivalent to the completion of the twelfth grade supplemented by college level coursework in health management, nursing, insurance, business, or a related field will be considered.

Experience :

At least three (3) years of experience in the fields of claims advocacy or claims handling including a minimum of two (2) years in a supervisory capacity, or an equivalent combination of education, training, and experience.

License or Certification :

Possession of a valid and current Driver’s License is required.

Certification as an CPWC-CA, WCAA, RN, or other related industry designation is preferred.

EMPLOYMENT ELIGIBILITY – The successful candidate must provide proof of employment eligibility and verification or legal right to work in the United States, in compliance with the Immigration Reform and Control Act

PHYSICAL DEMANDS AND WORKING ENVIRONMENT - The conditions herein are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential job functions.

Environment : Standard office setting; exposure to computer screens; working with fluorescent lighting. While performing the duties of this position, the employee regularly works indoors and will occasionally work outdoors. The employee must be able to meet deadlines with significant time constraints. The noise level in the work environment is usually moderate.

Physical : Sufficient physical ability to work in an office setting and operate office equipment; sit or stand for prolonged periods of time; lifting 25 lbs. maximum or carrying any object weighing up to 25 lbs.

Vision : See in the standard visual range with or without correction; vision sufficient to read computer screens and printed documents, including material sin handwritten, typewritten, digital, and photographic format.

Cognitive : Cognitive or analytical acuity, such as analyzing, counting, summarizing, synthesizing information from multiple sources, interpreting written or verbal instructions, and recognizing social or professional behavioral cues

Mental acuity : Mental acuity to facilitate injured employees’ return to work within the workers’ compensation claims environment, ergonomics, compliance and related programs and member services, evaluate and implement services for cost efficiency, interpret legal and regulatory compliance requirements, effectively communicate with Authority staff, members and vendors on a variety of routine and complex matters, consult with management or board governance on policy decisions, evaluate results and make recommendations relative to the effective performance of the tasks. Periodically must address difficult or contentious situations.

The above statements are intended to describe the general nature and level of work being performed by the people assigned to this position. They are not intended to be construed as an exhaustive list of all job responsibilities.

Schools insurance Group is a Joint Powers Authority who provides programs for property/liability, workers' compensation, employee wellness, and health benefits for over 30 school districts, county offices of education, and transportation authorities across 5 counties in the Northern California area.

Company Description

Schools insurance Group is a Joint Powers Authority who provides programs for property/liability, workers' compensation, employee wellness, and health benefits for over 30 school districts, county offices of education, and transportation authorities across 5 counties in the Northern California area.