Client Advocate Work Comp

Requisition ID
2017-7885
Category
Administrative Support
Facility
Community Medical Centers - Corporate Offices (CMC)
US-CA-Fresno
Posted Date
11/21/2017

Overview

The Client Advocate Work Comp is a vital member of our mission.

In this role you will be responsible for providing case management of workers’ compensation claims and leaves that are consistent with FMLA guidelines. Work collaboratively with injured workers and leadership to assure positive outcomes of transitional work assignments, as well as Employee Health Services, physicians and specialists to provide an early and safe return to work.  Assist in the ADA accommodation process for all related Qualified Injured Workers (QIW’s).  Work closely with CMC’s Third Party Administrator assuring efficient and effective handling of claims per CMC policies. 

 

Why are we the “Employer of first choice”?

We provide a world of opportunity for professional growth and personal advancement by making the health and financial security of our employee’s a top priority. We embrace our responsibility to the people who make us the largest private employer in the central San Joaquin Valley by offering comprehensive and affordable medical benefits as part of your employment with CMC.  We value giving you a choice in your health coverage by providing three medical plan options.  You will also be offered prescription drug, dental and vision coverage, paid time off, flexible spending accounts, life and disability insurance, discounts on many goods and services, and an employer matched Tax Sheltered Annuity Plan (403(b)).

Our team members enjoy additional benefits such as: education reimbursement, an employee gym, concierge service, and award winning cuisine. 

Based in Fresno, California, we are a multi-specialty healthcare system comprised of four hospitals; Community Regional Medical Center, Clovis Community Medical Center, Fresno Heart & Surgical Hospital, Community Behavioral Health Center. Additionally, our system includes other health care facilities and a physician residency program in conjunction with the University of California, San Francisco. Our primary service area is 15,000-square-miles, and we're home to the only combined, burn and Level 1 trauma center between Los Angeles and Sacramento. 

Community Medical Centers is an Equal Opportunity, Affirmative Action employer fully dedicated to achieving a diverse staff. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, veteran status, disability status, sexual orientation, gender identity, or any other protected status.

If you are looking to make a difference and value a purposeful, lasting career, we provide that in our 120 year old hospital system! For more information on why you should choose Community please click the link:https://www.communitymedical.org/

Responsibilities

  • Work as advocate to review workers’ compensation claims and monitor treatment provided to employees who have experienced an industrial injury or exposure to infectious disease. Communicate regularly with injured employees discussing questions and concerns to help reduce the risk of litigation.  
  • Provide timely administrative functions which include, but are not limited to, Workers compensation claim and OSHA data entry, retrieval of requested subpoenaed records, response to TPA inquiries and Patient Financial Services billing inquiries. Review feedback received from employees and departments in order to improve upon services.  
  • Manage return-to-work process in accordance with employee’s medical limitations. Work as liaison between workers’ compensation physicians, TPA, and Employee Health staff. Confer with adjuster, employee, and physician to ensure appropriate work status/care plan is carried out and recommend modifications are understood by manager and injured worker. 
  • Provide assessment of FMLA applications to determine if medical documentation supports proposed duration of claim. Work with HR staff on FMLA clarifications, as necessary. 
  • Work closely with Employee Health and Safety staff to provide manager and injured worker with appropriate education regarding injury and illness prevention, FMLA, rehabilitation, back school, work hardening, return to work programs and other options. 
  • Make recommendations for on-site case management services based on severity, longevity of case and risk for litigation, as needed. 
  • Facilitate the QIW interactive job search process in accordance with required timelines and assure accurate documentation and communication throughout. 
  • Actively participate in Quarterly Claim Review meetings as well as department meetings. Assure clear understanding through appropriate communication and recommendations pertaining to claim activity/processes, estimated returns, and next steps.
  • Identify adverse trends regarding departmental injury rates, Return to Work related issues, claim handling concerns and develop appropriate escalation plan to negate negative impact.

Qualifications

Minimum required:

High School diploma/GED. Three to five years Workers' Compensation Claims Management experience including Return to Work Program, Utilization Review, AME and QME Process.

 

Preferred: 

Bachelor's degree in Business or related field.

 

Licenses/Certifications:

 

Minimum required: N/A

 

Preferred: 

EA Workers Compensation Professional Certificate. Self Insurance Plans Certificate. FMLA and ACOEM training and/or certificates.

Options

Sorry the Share function is not working properly at this moment. Please refresh the page and try again later.
Share on your newsfeed