Workers Compensation and Leave Administrator

San Juan Regional Medical Center•Farmington, NM

10d

About The Position

Creating Life Better Here starts with you. At San Juan Regional Medical Center, we're more than a healthcare provider—we're a values-driven organization dedicated to delivering exceptional care. As a team member, you help fulfill our mission to make life better here for our community. The Workers’ Compensation and Leave Administrator assists employees who sustained an “on-the-job” injury with the workers’ compensation process. They are responsible for helping employees seek immediate and future medical treatment consistent with conditions inherent in, and regulations governing, the operation of the organization. This position is also responsible for administering the end-to-end workers’ compensation process, maintaining detailed, compliance documentation and records, creating reports, and communication with employees, leadership, insurance carriers, legal counsel, and other San Juan Regional Medical Center (SJRMC) departments. This role also administers employee leave programs, including FMLA and other statutory or organizational leave, ensuring accurate tracking, regulatory compliance, and coordinated communication with employees, leadership, and relevant departments. Required Behaviors: As you go about fulfilling this mission, your work habits and work relationships should embody SJRMC's values. These values are our culture, our identity as an organization. Sacred Trust, Personal Reverence, Thoughtful Anticipation, Team Accountability, and Creative Vitality ask more of us than merely completing some list of tasks. Our values ask for a deeper level of commitment, and what is asked of us we freely give because we believe in our mission.

Requirements

Associate’s Degree in Safety Engineering, Risk Management, Human Resources, Business (or related field) or any equivalent combination of training and experience
Four (4) years of experience in workers’ compensation or human resources
Proficient in all Microsoft Office Applications (Outlook, Word, Excel, and PowerPoint)
Working knowledge of the Worker’s Compensation Act and other applicable state/federal statutes and regulations
Working knowledge of employee leave administration, including FMLA and other statutory or organizational leave programs, with the ability to ensure accurate tracking, documentation, and regulatory compliance
Working knowledge of medical terminology, anatomy, and/or impairments and their disabling effects
Ability to obtain facts that ensure that claims information is complete and accurate
Ability to balance casework loads and efficiently process claims
Good judgment in interpreting medical facts presented by a physician and applying these facts in determining an individual’s capacity to engage in gainful occupation
Ability to read, assimilate, and recall with marked proficiency: facts, figures, and descriptions, and to search for and obtain information
Ability to maintain satisfactory working relationships with employees, leadership, the general public, and other agency personnel
Working knowledge of the tenets of supervision and motivation of employees
Ability to read, analyze, and interpret general business periodicals, professional journals, technical procedures, or government regulations
Ability to write reports, business correspondence, and procedure manuals
Ability to effectively present information and respond to questions from leadership, agencies, and legal counsel
Ability to apply concepts such as fractions, percentages, ratios, and proportions to practical situations
Ability to define problems, collect data, establish facts, and draw valid conclusions
Ability to interpret an extensive variety of technical instructions in mathematical or diagram form and deal with several abstract and concrete variables
Must be proactive in promoting the culture of safety to meet all safety goals
Ability to display good judgment, tact, discretion, and initiative

Nice To Haves

Bachelor’s Degree in Safety Engineering, Risk Management, or related field
Advanced Certification (SHRM-CP, SHRM-SCP, etc.)
At least five (5) years of experience in workers’ compensation, risk management, human resources, business (or related field), or any equivalent combination of training and experience
Successful completion of courses in worker’s compensation administration, medical terminology, anatomy, or similar training

Responsibilities

Maintains all Workers’ Compensation claims and records with accuracy, integrity, and confidentiality.
Reports all claims of employee OSHA reportable injuries to Third Party Administrator in a timely manner (include an E-1 or equivalent from the reporting system, an Injury Report, medical records release forms, and medical records of the visit and treatment of the employee).
Maintains an accurate tracking system, records, and logs to enable compliance with OSHA record keeping and annual filing requirements and reporting to the Department of Labor as required annually, along with compliance with state workers’ compensation laws, and accreditation standards.
Provides guidance and support of the Workers’ Compensation Process to all injured employees (this may include completion of paperwork, providing claim status updates, providing return to work information including time loss and restrictions, payment of medical bills, and familiarity with the referral process).
Tracks and reports all infection control exposure and needle stick incidents to OSHA.
Tracks and monitors all incidents that do not turn into worker’s compensation claims.
Performs as liaison for all ERGO Assessments; collecting required information for the Physical Therapy Department to perform the ERGO Assessment and then notifying the requesting department leaders when the assessment is complete.
Provides department leaders with resources (i.e., forms, training, etc.) and educates employees on workers’ compensation benefits, timelines, and coordination with other Total Rewards Programs (i.e., leaves of absence, disability, etc.).
Serves as the internal point of contact for employee leaves of absence administered through a third-party vendor, coordinating information exchange, documentation, and timelines between the vendor, employees, leadership, and internal departments.
Ensures accurate coordination between workers’ compensation claims and vendor-managed leave programs (e.g., FMLA, medical, and other statutory leaves), including monitoring status, resolving discrepancies, and supporting return-to-work and benefit integration.
Active member of the Safety Committee and the Employee Safety Steering Committee and provides safety recommendations to help prevent future workers’ compensation claims.
Collaborates with various departments (i.e., Risk Management).
Actively participates in the SJRMC Safety Advocate Program.
Assumes responsibility for writing off initial, first visits to Urgent Care/ED by employees in a timely manner (related to workers’ compensation claims).
Works closely with employees, leadership, Third-Party Administrators, Urgent Care, legal counsel, Physicians, case assigned adjusters, Nurse Case Managers, the Department of Labor, and various SJRMC departments to identify and implement modified duty assignments.
Attends various meetings and provides OSHA reportable reports of employee injuries to the Safety Committee.
Maintains compliance with OSHA reporting (i.e., maintains an accurate tracking system, records, and logs to enable compliance with OSHA recordkeeping and annual filing requirements and reporting to the Department of Labor as required annually, along with compliance with state workers’ compensation laws, and accreditation standards.
Assumes responsibility for data entry and creating correspondence and reports.
Participates in appropriate education/training programs and attends required meetings related to Workers’ Compensation.
Manages the employee injury events in the current Quantros reporting system as event manager.
Maintains established departmental policies and procedures in PolicyTech.
Completes annual Insurance Renewal Applications, audits and financial reporting, by collaborating with other departments, external vendors, etc.
Manages the Master Authorized Drivers List.
Manages the Master Property List
Prepares and analyzes insurance report requests (i.e., Run Loss Reports, claim volume, lost time, financial impact, etc.) and reviews claim activity and settlement recommendations for accuracy and alignment with organizational goals.
Monitors claim costs, trends, and utilization to support cost-containment strategies
Completes insurance applications for accident, traveler, safeguard new business, workers compensation, by collaborating with other departments, external vendors, etc. (i.e., AIG, Chubb, Beazley, Safety National, out-of-state Workers’ Compensation renewal).
Provides excellent customer service (i.e., answers phones, transfers calls, checks and responds to voicemail and email, etc.).
Performs vendor relationship management responsibilities (i.e., inquiries from vendors, completing forms to our organization, insurance cancellation notices, etc.).
Performs case management responsibilities (i.e., create and revise various processes, communication with various departments and vendors, create custom reports regarding leaves, status, start/end dates, etc.).
Makes timely updates to employee records, uploads documents, etc.
Creates monthly meetings with vendors (i.e., status of cases, etc.).
Performs leave management responsibilities (i.e., data entry, communication with employees and managers, etc.).
Provides employee counsel on policies and procedures.
Conducts leaves investigations and mediate relations.
Each employee is responsible for implementing SJRMC’s Service Standards into their daily work: Safety, Courtesy, Effectiveness, and Stewardship
Performs other duties as assigned or requested