Workers Compensation Return to Work Case Manager - Richmond, VA

Military Spouse Corporate Career Network•Richmond, VA

1d•Onsite

About The Position

This role involves managing Workers' Compensation claims with lost time to conclusion and negotiating settlements where appropriate. The position requires coordinating the medical and indemnity aspects of claims, independently handling claims of low to moderate complexity, and potentially managing claims of greater complexity with moderate supervision. The goal is to achieve a positive outcome by returning injured workers to work, either modified or full duty, or obtaining Maximum Medical Improvement (MMI) with no Return to Work (RTW). The role also involves establishing and updating reserves, determining causal relatedness of medical conditions, managing file quality, and collaborating with internal and external resources such as Medical Case Managers and legal counsel. The position requires understanding and applying Medicare Set Asides, negotiating settlements, and potentially obtaining and maintaining insurance licenses. The annual base salary range for this position is $67,000.00 - $110,600.00, with one target opening. This role is open to Veterans, Transitioning Military, National Guard and Reserve Members, Military Spouses, Wounded Warriors, and their Caregivers.

Requirements

Manage Workers' Compensation claims with lost time to conclusion.
Negotiate settlements where appropriate.
Coordinate medical and indemnity position of the claim with a Medical Case Manager.
Independently handle assigned claims of low to moderate complexity.
Handle claims of greater complexity with close to moderate supervision.
Conduct investigations, including assessing policy coverage, contacting insureds, injured workers, medical providers, and other parties.
Establish and update reserves to reflect claim exposure and document rationale.
Identify and set actuarial reserves.
Determine causal relatedness of medical conditions.
Manage files with an emphasis on file quality (timely contact, proper documentation, proactive resolution).
Achieve a positive end result by returning injured party to work and coordinating appropriate medical treatment.
Work in collaboration with specialty resources (medical and legal).
Develop strategies to manage losses involving statutory benefit entitlement, medical diagnoses, Medicare Set Aside.
Collaborate with internal nurse resources (Medical Case Manager).
Prepare necessary letters and state filings within statutory limits.
Pursue all offset opportunities, including apportionment, contribution and subrogation.
Evaluate claims for potential fraud.
Proactively manage inventory with documented plans of action.
Effectively manage litigation to drive files to an optimal outcome.
Understand and apply Medicare Set Asides and allocations.
Negotiate settlement of claims within designated authority.
May use structured settlement/annuity as appropriate for the jurisdiction.
Acquisition and maintenance of Insurance License(s) may be required to comply with state and Travelers requirements.
License(s) must generally be obtained within three months of starting the job.
Obtain ongoing continuing education credits as mandated.

Nice To Haves

Claims involving minor sprains/ minor to moderate surgery.
Injured worker is working modified duty and receiving ongoing medical treatment.
Injured worker has returned to work, reached Maximum Medical Improvement (MMI) and is receiving PPD benefits.
Injured worker (IW) remains out of work and unlikely to return to position.
Employer is unable to accommodate the restrictions.
Claim involves moderate to complex litigation issues.
IW has returned to work, reached Maximum Medical Improvement (MMI), and has PPD.
File litigated to dispute the permanency rating and/or causality.
IW has been released to work with permanent restrictions and there has been a change in the current position.
IW is receiving Vocational Rehabilitation.
Claims that have been reopened for additional medical treatment on more complex files.
Injuries may involve one or multiple back, shoulder or knee surgeries, knee replacements, claims involving moderate to complex offsets, permanent restrictions and/or fatalities.
Claims on which a settlement should be considered.

Responsibilities

Manage Workers' Compensation claims with lost time to conclusion and negotiate settlements where appropriate.
Coordinate medical and indemnity position of the claim with a Medical Case Manager.
Independently handle assigned claims of low to moderate complexity where wage loss and the expectation is a return to work to modified or full duty or obtain MMI with no RTW.
Conduct investigations, including assessing policy coverage, contacting insureds, injured workers, medical providers, and other parties to determine compensability.
Establish and update reserves to reflect claim exposure and document rationale.
Identify and set actuarial reserves.
Apply knowledge to determine causal relatedness of medical conditions.
Manage files with an emphasis on file quality (including timely contact and proper documentation and proactive resolution of outstanding issues).
Achieve a positive end result by returning injured party to work and coordinating the appropriate medical treatment in collaboration with internal nurse resources where appropriate.
Work in collaboration with specialty resources (i.e. medical and legal) to proactively pursue claim resolution opportunities (i.e. return to work, structured settlement, and discontinuation of benefits through litigation).
Develop strategies to manage losses involving issues of statutory benefit entitlement, medical diagnoses, Medicare Set Aside to achieve resolution through the best possible outcome.
Collaborate with internal nurse resources (Medical Case Manager) to integrate the delivery of medical services into the overall claim strategy.
Prepare necessary letters and state filings within statutory limits.
Pursue all offset opportunities, including apportionment, contribution and subrogation.
Evaluate claims for potential fraud.
Proactively manage inventory with documented plans of action to ensure timely and appropriate file closing or reassignment.
Effectively manage litigation to drive files to an optimal outcome, including resolution of benefits.
Understand and apply Medicare Set Asides and allocations.
Negotiate settlement of claims within designated authority.
May use structured settlement/annuity as appropriate for the jurisdiction.
Perform other duties as assigned.