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Workers Compensation Claims Specialist

Company: Palomar Health
Location: Escondido
Posted on: May 12, 2022

Job Description:

Under the direct supervision of the Manager of Employee Health and Workers' Compensation, the Workers' Compensation Specialist is responsible for the day to day aspects of the Palomar Health's Workers Compensation program. Responsibilities include but are not limited to the following: claims management, modified duty program, and employee advocacy. Coordinates medical care and workers compensation benefits for injured employees. Works directly with the medical director, Third Party Administrator, medical providers, and other claim partners. Serves as the subject matter expert in patient care case management of injured employees through the California Workers Compensation system. Enhances the quality of patient management and satisfaction by increased employee communication, removal of care obstacles and promotes cost effective care with the goal of returning the employee to their pre-injury state as quickly as possible. Works collaboratively with the Employee Health Medical Director, Employee Health Nurse, and Safety Officer in setting goals and standards for a safe work environment and protection of Palomar Health employees. Develop and report statistics regarding work injuries for communication to department directors, infection control, and safety committee. Functions as subject matter expert in interdisciplinary rounds to identify employees with additional occupational needs.
Ability to speak and read English at a level that is sufficient to satisfactorily perform the essential functions of the position. Knowledge of standard office equipment (i.e., calculator, fax, photocopier) and personal computer and computer software skills (i.e., MS Windows, Excel, Access, Word, PowerPoint, internet, e-mail). Windows computer skills including proficient use of keyboarding, use of mouse or keys for functions such as selecting items, use of drop down menus, scroll bars, opening folders, copying and similar operations required upon employment or within the 1st two weeks of employment to perform the essential functions of the job. Performs other duties as assigned. Follows Palomar Health rules, policies, procedures, applicable laws and standards. Carries out the mission, vision, and quality commitment of Palomar Health.Job RequirementsMinimum Education: Associates Degree or equivalent combination of education and experience

Preferred Education: Bachelor's Degree

Minimum Experience: 2-4 years California Workers Compensation claims or related experience

Preferred Experience: 5+ years California Workers Compensation claims related experience

Required Certification: American Heart Association recognized BLS - Healthcare Provider

Preferred Certification: Certified Disability Management Specialist

Required License: Valid Driver's License

Preferred License: CA RN or LVN License


Keywords: Palomar Health, Escondido , Workers Compensation Claims Specialist, Other , Escondido, California

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