- Serve as a resource for claims adjusters and policy holders.
- Assist and support the business group leader through the facilitation of claims team meetings and staffing as requested.
- Provide case management direction to outside field case managers including medical, return to work, physical restoration, vocational testing, job search, and re-training.
- Keep apprised of emerging workers' compensation trends, such as legal decisions, penalties, settlements, and industrial injuries.
- Perform claims analysis and identify trend factors on known high value incidents as requested and provide the information to the Business Teams.
- Assist in the coordination of all aspects of disability management by ensuring an effective and efficient workflow of all disability management procedures and projects for the Business Groups as assigned.
- Coordinate the disability management of complex and high exposure cases to facilitate a prompt, effective resolution.
- Remain current with and adhere to best claim practices for return-to-work methodology.
- Introduce new techniques and ideas to the Business Group to streamline procedures and produce cost savings through increased understanding of effective disability management.
- Provide claims adjuster support and follow-up in an effort to achieve successful return to work through individual or group staffing.
- Assist employer in developing or refining return-to-work programs.
- Assist employer with completion of functional job descriptions.
- Coordinate return to work efforts with internal Nurse Case Managers and resolve customer service inquiries for external field case managers regarding authorizations, case staffing, and case direction.
- Develop and approve in-house vocational rehabilitation plans.
- Refer claims for task assignment or an initial vocational evaluation as appropriate and provide oversight of field assignments for outcome and possible re-direction or re-assignment where needed.
- Review active claims for possible rehabilitation intervention.
- Authorize appropriate rehabilitation plans and develop process improvement plans supporting the team's return to work initiatives.
- Manage assigned workflow, to include the review of reports submitted by external field case managers, authorizing hours per the field case management activities, and approving vocational rehabilitation plans.
- Assist with identifying and recommending efficiencies through technology.
- Develop and participate in high exposure cases, including round table, medical/legal discussions, and rehabilitation staffing, to assist in the claims management process.
- Participate in authority issues regarding settlements. Review and monitor reserves within designated allocation.
- Periodic travel, including meetings with policyholders.
- Non-essential function: other duties as assigned.
- Bachelor's degree from an accredited college or university required; preferably in counseling, psychology, social work, nursing, business, risk management, insurance or human resources.
- At least four years of full-time or equivalent part-time paid experience in field case management or a related field preferred.
- Master of Science degree in rehabilitation counseling preferred.
- In jurisdictions where required, holds designation(s) such as rehabilitation provider or case management. In jurisdictions where not required, the designation(s) is preferred.
- In jurisdictions where required, holds at least one professional designation, such as CRC, CCM, or CDMS. In jurisdictions where not required, the designation(s) is preferred.
- Relevant expertise in the field of case management preferred.
- Substantial knowledge of workers' compensation and/or casualty claims management.
- Exceptional communication skills, with participation in a team environment and proven record of ability to collaborate with other business units for information gathering, reporting results, training, etc.
- Effective organizational skills including the ability to manage multiple projects and work with minimal direction.
- Excellent analytical research and documentation writing skills.
- Knowledge of medical terminology, medical codes and medications.
- Knowledge and skills to review medical case management results and to ensure the delivery of high-quality services in compliance with industry best practices, internal policies and approved medical guidelines.
- The ability to provide efficient and effective customer service to internal and external customers.
- Working knowledge of Microsoft Word, Excel and PowerPoint.
- Ability to work effectively in a paperless environment.
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Return To Work Specialist - Illinois, United States - Encova
Description
The salary range for this job posting is $60, $107,944.00 annually + bonus + benefitsThe above represents the salary range for this job requisition. Ultimately, in determining your pay, we'll consider your location, education, experience, and other job-related factors. Your recruiter can share more information about the specific salary range during the hiring process.
This role will work remote from home and report to a Director, Workers' Compensation Claims.
We can hire a senior level depending on candidate qualifications and the compensation range shown is inclusive of both levels.
Candidates should have the willingness and ability to travel as needed.We are open to consider candidates who do not reside in IL but within one of our listed payroll approved states.
JOB OBJECTIVE:
The Return to Work Specialist supports the efforts of the team to seek opportunities for early intervention to identify early return to work opportunities and deployment of Field Case Managers to assist the adjuster to achieve the most cost-effective and positive outcome from work-related injuries.
ESSENTIAL FUNCTIONS:
OTHER FUNCTIONS:
KNOWLEDGE, SKILLS AND ABILITIES:
Encova Insurance makes every effort to reasonably accommodate disabilities to permit performance of the essential functions and candidates who need such accommodation are encouraged to seek it.
This description reflects the nature and level of work performed by associates in this position. It is not an all-inclusive inventory of duties, responsibilities and qualifications required. It provides an accurate overview of the work and skills needed to perform this position.Because job content may change from time to time, Encova Insurance reserves the right to add and/or delete functions from this job as it deems necessary for business reasons.
Ready to join our team?
At Encova Insurance, we firmly believe that our associates drive our company's success by delivering unrivaled service to our customers.
With success in mind, we make an ongoing effort to provide an environment that offers challenging, stimulating and financially rewarding opportunities.
Join us to discover a work experience where your diverse ideas will be met with enthusiasm - where you can learn and grow to your fullest potential.
Join our family of industry leaders, and let us reward you with a competitive salary, bonus and benefits package that includes but is not limited to: a 401(k), wellness programs, bonus incentive plans and flexible schedules, with an early close of the office every Friday.
Additionally, Encova aspires to be an outstanding corporate citizen in all the markets we serve; we encourage and support associate participation in community initiatives through our foundations.
Encova Insurance is an EOE/E-Verify employer.
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