Workers' Compensation Case Coordinator

American Family Care NW Fresno•Fresno, CA

3h•$20 - $25

About The Position

The Workers’ Compensation Case Coordinator is responsible for facilitating and overseeing the care of patients with work-related injuries. This role ensures timely authorization, treatment, and communication between injured workers, providers, employers, insurance adjusters, and case managers. The Coordinator helps manage claims, supports return-to-work goals, and ensures all documentation and services are compliant with workers’ comp regulations and payer requirements. This position coordinates all workers compensation activities, including obtaining medical authorization and processing dictated reports. It requires strong organizational skills and attention to detail.

Requirements

Minimum 1 years of experience in Workers’ Compensation, healthcare administration, or related field
Able to effectively manage a workers' compensation file under the supervision of assigned supervisor
Knowledge of insurance verification and billing & coding experience is a plus
Certification in workers' compensation administration or a related field is a plus
Understanding of California's workers' compensation system, including relevant laws, regulations, and procedures
Familiarity with medical terminology and understanding of healthcare processes related to workers' compensation claims
Maintaining accurate and up-to-date records of all claims, communications, and activities related to the workers' compensation process
Experience working with insurance providers, legal professionals, and healthcare providers related to workers' compensation claims
High Attention detail
Ability to handle stressful situations and work well under pressure
Ability to work independently and as part of a team, collaborating with various stakeholders
Excellent communication, organization, and time management skills
Self-starter - able to work with limited supervision
Ability to multi-task and prioritize in a fast-paced environment
Friendly and professional and flexible
General office skills, 35 wpm keyboard speed, computer experience including but not limited to Microsoft Office, web-based applications, e-mail, internet, fax machine, and copy machine

Nice To Haves

Education in Medical Career Courses preferred, but not required
Bilingual in Spanish preferred, but not required

Responsibilities

Client communication via phone and email
Scheduling medical appointments for clients
Communicating case status to clients
Responding to client, adjuster, and legal calls
Requesting records from referral sources and medical offices
Confirming medical appointments
Provide timely reports upon request via fax, email or US mail
Coordinate all aspects of care for patients with active workers’ compensation claims
Receive and process referrals from adjusters, nurse case managers, and providers
Maintain updated tracking list for all workers’ compensation accounts
Confirm claim details, authorizations, and coverage with insurers and third-party administrators (TPAs)
Schedule appointments and facilitate the authorization of DME, therapy, diagnostics, prescriptions, or follow-up care
Ensure required documentation is complete, including medical records, work status reports, and treatment plans
Maintain open communication with all stakeholders: injured workers, employers, adjusters, nurse case managers, and treating physicians
Monitor claim progress, follow up on pending authorizations, and escalate delays when needed
Report modified work duties and return-to-work plans in collaboration with providers and employers
Update case notes, status logs, and electronic health records (EHR) in a timely and accurate manner
Ensure services comply with jurisdiction-specific workers’ compensation laws and organizational protocols.
Maintain confidentiality and adhere to HIPAA and workers’ compensation regulations.
Maintain accurate and up-to-date records of all workers' compensation claims, ensuring compliance with legal requirements and company policies.
Perform other duties as assigned