Workers' Compensation Claims Coordinator
Company: AHMC Healthcare
Location: Alhambra
Posted on: May 25, 2023
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Job Description:
Primary Function
As a Workers Comp Claims Coordinator is responsible for the
investigation, evaluation, disposition and settlement of the most
complex claims and highest exposures. This includes the
investigation, determination and evaluation of coverage, liability
and damages, and the evaluation of proper reserves.
Nature and Scope (Essential Functions)
1. Exercises proper judgment and decision making to analyze the
claims exposure, to determine the proper course of action to
appropriately settle the claim
2. Interacts extensively with various parties involved in the claim
process
3. Utilize critical thinking and solid judgment to solve problems,
make decisions and resolve complex issues inherent in handling
losses, as well as plan and organize activities throughout the
claims management process
4. Communicate with external claims adjuster to enable the
successful settlement and disposition of serious claims.
5. Documents and communicates all claim activities timely and
effectively and in a manner which supports the outcome of the claim
file
6. Handles claims consistent with "Best Practices", and also in
accordance with any statutory, regulatory and ethics
requirements
7. The incumbent directs services and management training related
to workers comp.
8. The incumbent is responsible for keeping abreast of relevant
issues that impact workers comp and communicates to members of the
administrative team, facilities management team and facilities
human resources departments.
9. The incumbent will review the investigation documentation
thoroughly and make appropriate recommendations to resolve concerns
brought to the attention of administration, human resources
departments.
10. The incumbent is responsible for coordinating weekly claims
review meetings with appropriate parties to ensure the handling of
WC claims is being done accurately and timely.
11. The incumbent works in collaboration with internal and external
resources in order to achieve best outcomes.
12. The incumbent develops an operating budget, monitors, analyses
and implements controls to ensure that the assigned areas operate
within approved budget.
13. The incumbent develops and analyses reports to provide educated
sound recommendations related to programs and other activities
related to workers comp.
14. The incumbent participates in developing, implementing and
evaluating programs to effectively impact the workers compensation
program.
15. The incumbent ensures regulatory compliance.
16. Incumbent is responsible for managing the workers compensation
claims in compliance with all state and federal laws.
17. Keeps immediate supervisor informed of any benefit related
concerns/issues and collaborates to address issues on a timely
basis.
18. Works collaboratively with AHMC colleagues to deliver
exceptional customer service and build cohesive interdepartmental
relationships.
19. Assists the facilities in addressing complex WC claim
issues.
20. Performs other duties as assigned or required.
Qualifications
1. Bachelors (BS or BA) degree in a field of study related to this
position preferred.
2. Minimum 5 years experience as a workers compensation
adjuster.
3. Five or more years of claims-related experience with a
consistent high level of performance and achievement
4. Workers Compensation Claims Administrator Certificate (WCCA)
and/or Workers Compensation Claims Professional (WCCP) preferred
but not required.
5. Extensive knowledge of accepted industry standards and
practices
6. Ability to effectively operate a computer, knowledge of MS
Office applications, and related claims and business software.
7. Knowledge state workers compensation laws.
8. Possess excellent negotiating skills and communication
skills.
9. Ability to communicate effectively with internal and external
resources.
10. Must possess excellent human relation skills.
11. Must possess excellent critical thinking skills.
12. Possess strong organizational skills with ability to
multi-task, and prioritize workload.
Accountability
1. The incumbent is responsible for managing the workers comp cases
to achieve targeted outcomes.
2. This position is responsible for promoting an environment of
teamwork with all members of the organization.
3. The incumbent is responsible for assuring the assigned area(s)
are in compliance with hospital policies and procedures.
4. This position is accountable for meeting budgetary
expectations.
5. This position is responsible for assuring departments are in
compliance with the organizations workers comp policies and
procedures.
6. The incumbent is accountable for communicating to the internal
resources of any possible issues which may arise in order to
proactively develop an action plan to minimize or eliminate the
issue.
7. The incumbent is responsible for acting in an ethical manner at
all times.
8. The incumbent is accountable for maintaining confidentiality on
sensitive matters.
9. The incumbent is responsible for complying with all company
policies and procedures.
10. The incumbent is responsible for complying with all local,
state and federal laws.
Dimensions
AHMC provides management services to AHMC Anaheim Regional Medical
Center with 223 beds, Garfield Medical Center with 211 beds,
Greater El Monte Community Hospital with 115 beds, Monterey Park
Hospital with 102 beds, San Gabriel Valley Medical Center with 273
beds, Seton Medical Center with 357 beds, Seton Medical Center
Coastside, a 116-bed skilled nursing facility, and Whittier
Hospital Medical Center with 172 beds. The facilities are Medicare
and Medi-Cal certified and accredited by The Joint Commission on
Accreditation of Healthcare Organizations. The hospitals provide
healthcare services reimbursed by Medicare, Medi-Cal, traditional
insurance plans, PPO, HMO and under capitated arrangements.
iCIMS Assigned Requisition ID: req17931
Facility Name: Corporate Office
Shift: Days
External Company Name: AHMC Healthcare
Street: 1000 Fremont Ave
Keywords: AHMC Healthcare, Alhambra , Workers' Compensation Claims Coordinator, Other , Alhambra, California
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