Workers Compensation Case Manager Resume
Summary : As a Workers Compensation Case Manager, responsible for managing complex cases and facilitating the coordination of medical treatment and rehabilitation services for injured workers. Developing comprehensive care plans, and ensuring timely and appropriate interventions to facilitate maximum recovery and return to work outcomes.
Skills : Case Management, Communication.
Description :
- Gathered all pertinent information regarding workplace injuries and ensured the proper provincial forms were submitted within appropriate timelines.
- Determined an appropriate stay at work, or return to work plan with the employee, employer, workers’ compensation representatives, and other stakeholders as required.
- Provided timely and active support for the return-to-work planning process and support as needed.
- Prepared and submitted objections to WCB when appropriate and ensured proper follow-up with the provincial board until a decision was made.
- Communicated effectively with all stakeholders to keep all parties involved in the injured worker’s claim.
- Liaised with Human Resources and Benefits Team members and with medical professionals regarding case management aspects.
- Resourced to employees and management on Workers’ Compensation and return to work matters.
Experience
10+ Years
Level
Senior
Education
Bachelor's Degree in Nursing
Workers Compensation Case Manager Resume
Summary : As a Workers Compensation Case Manager, manages monetary aspects of assigned claims by establishing appropriate reserves and authorizing payment or facilitating denial of the claim, engaging in negotiations with minimal supervision.
Skills : Knowledge of Workers' Compensation Laws, Medical Terminology.
Description :
- Managed, assigned, and oversaw caseload for the WCB Generalist and any outside contractors.
- Respected and protect the privacy of information relating to employees and the business.
- Maintained records, and statistics, prepared reports, and made recommendations for continual improvement.
- Met with clients to review internal workplace injury issues.
- Managed workplace injury claims, minimizing time-loss and claim costs through early intervention and proactive coordination of services.
- Provided input in stakeholder case conferences to progress claims.
- Liaised with internal managers and educated them on obligations.
Experience
7-10 Years
Level
Management
Education
Bachelor's Degree in Healthcare Administration
Workers Compensation Case Manager Resume
Objective : As a Workers Compensation Case Manager, provides service to customers by sharing information, discussing resolution strategies with counsel, developing relationships with support areas, and providing guidance or suggestions to customers on alternate strategies, reserve assessment, and how to handle complex situations.
Skills : Problem-Solving, Empathy.
Description :
- Ensured regular and open lines of communication with clients, injured workers, and the provincial Workers’ Compensation Boards.
- Liaised with the provincial Workers’ Compensation Boards.
- Interpreted provincial workers’ compensation legislation, policies, and procedures.
- Filed reports of injury, identified appeal issues, drafting letters of objection.
- Coordinated case management activities including developing, implementing, and monitoring return to work and rehabilitation strategies.
- Facilitated 3rd party interventions (functional capacity evaluations, independent medical evaluations).
- Kept accurate medical records on workers' compensation cases.
Experience
2-5 Years
Level
Executive
Education
Bachelor's Degree in Business
Workers Compensation Case Manager Resume
Summary : As a Workers Compensation Case Manager, manages moderately complex workers' compensation claims by investigating the facts of the case, determining compensability, evaluating medical records and physician recommendations; and utilizing medical and legal resources.
Skills : Negotiation, Time Management, Documentation.
Description :
- Triaged urgent issues from rehabilitation clinics, and elevated necessary concerns to the supervisor.
- Ensured compliance with standard work, made recommendations for process improvement as it relates to worker’s compensation administrative requirements, communication and clinically preparing patients for return to work.
- Provided coaching and positive dialogue among staff members to develop their knowledge of worker’s compensation enabling us to become a preferred provider with employers/insurance companies.
- Facilitated return to work for rehabilitation patients.
- Triaged FCE referrals to ensure appropriateness for scheduling and safety for testing.
- Provided administrative support for TPA contracts to ensure reimbursement of services and good standing with TPA companies.
- Communicated with an injured employee's healthcare providers.
Experience
7-10 Years
Level
Consultant
Education
Bachelor's Degree in Healthcare Administration
Workers Compensation Case Manager Resume
Summary : As a Workers Compensation Case Manager, provides and supports the implementation of business solutions by building relationships and partnerships with key stakeholders, identifying business needs, and determining and carrying out necessary processes and practices.
Skills : Leadership and management.
Description :
- Kept payers up-to-date on medical details and progress.
- Facilitated approvals from payers for treatment.
- Evaluated care quality and cost efficiency.
- Helped the injured employee understand his or her condition and treatment details.
- Worked with employers to facilitate any necessary job modifications to enable a timely return to work.
- Provided information and acted as the Company liaison to explain benefits provided through Workers’ Compensation.
- Maintained close working relationships with plant Health Services, Safety, Human Resources, Operations, and Corporate Risk Management.
Experience
7-10 Years
Level
Consultant
Education
Bachelor's Degree in Business
Workers Compensation Case Manager Resume
Summary : As a Workers Compensation Case Manager, responsible for assisting employees on behalf of the employer when the employee is off work, or at risk of being off work, due to a workplace injury.
Skills : Knowledge of employment laws, Litigation.
Description :
- Developed individual medical case management plans for injured employees.
- Coordinated the exchange of information among the Health Services staff, the HR staff, and the TPA to avoid errors and/or delays in claims submission/payment.
- Led weekly claim reviews of all open cases with a focus on return to work and claim closure/resolution.
- Communicated loss experience and data analysis to Health Services, Safety, and Risk Management to report on a weekly basis.
- Assisted with continuous quality improvement of Workers’ Compensation claims submission policies, procedures, processes, and programs.
- Consulted with corporate risk management on settlement and reserve valuations.
- Made appropriate recommendations on return to work, settlement, or other case closure opportunities.
Experience
10+ Years
Level
Senior
Education
Bachelor's Degree in Business
Workers Compensation Case Manager Resume
Summary : As a Workers Compensation Case Manager, assesses any barriers to a successful and timely return to work and engages with stakeholders to implement strategies to address those identified barriers and support return to work or an appropriate alternative plan.
Skills : Litigation management, Employee benefits design.
Description :
- Initiated permanent placement process once permanent restrictions are assigned.
- Assisted with the development and distribution of claim management and financial reports (ad hoc, monthly, quarterly, and annual).
- Maintained accurate workers’ compensation records and reports to comply with federal and state record-keeping requirements.
- Established and maintained professional relationships with employees from all levels of the business as well as with doctors, medical professionals in the community, and company attorneys.
- Attended doctor appointments when necessary.
- Helped cover department vacancies when needed, possibilities of weekend coverage, and perform any other duties as assigned.
- Provided early, timely personal customer-focused, and empathetic service to injured workers and employers.
Experience
7-10 Years
Level
Management
Education
Bachelor's Degree in Social Work
Workers Compensation Case Manager Resume
Summary : As a Workers Compensation Case Manager, provides workers compensation case management, physician liaison, and facilitation of communication to all members of the health care team. Tracks trends and issues regarding access to rehabilitation services.
Skills : Strong analytical and mathematical skills.
Description :
- Proactively and effectively managed all aspects of a caseload of worker's compensation claims within the legislation and compliance guidelines.
- Delivered the desired customer experience to all stakeholders and managed the end-to-end outcomes for a portfolio of cases.
- Provided accurate and complete information that is consistent and easy to understand (including options about any claim, entitlements, obligations, and responsibilities).
- Conducted claims reviews, case conferences, or face-to-face meetings with clients as required.
- Managed a diverse portfolio of claims for corporate clients or government clients.
- Worked in partnership with internal and external stakeholders meeting service principles.
- Determined liability and timely assessment of treatment requests.
Experience
7-10 Years
Level
Management
Education
Bachelor's Degree in Business
Workers Compensation Case Manager Resume
Summary : As a Workers Compensation Case Manager, communicates with injured employees about work-related injuries. Provides case management of work-related injury/illness. Liaison with third-party administrators, legal representation, and outside nurse case managers.
Skills : Decision-making skills, Leadership skills.
Description :
- Appropriately documented claims decisions.
- Utilized claims management systems.
- Developed and implemented claims strategies that deliver positive and sustainable outcomes.
- Met key compliance and performance measures.
- Coached and supported newer team members.
- Ensured customer service standards are maintained and responsibility is taken for prompt resolution of issues/complaints.
- Proactively managed claims, identifying, and managing return to work barriers on individual claims, and implementing strategies to address these.
Experience
7-10 Years
Level
Management
Education
Bachelor's Degree in Business
Workers Compensation Case Manager Resume
Objective : As a Workers Compensation Case Manager, tracks work-related injury/illness for trending purposes. Analyzes data and prepares appropriate reports. Maintains updated job descriptions. This includes knowledge of workers' compensation law. Provides monthly, quarterly, and end-of-year statistics.
Skills : Negotiation skills, Decision making.
Description :
- Ensured data is maintained through correct data entry.
- Effectively set expectations, communicate, and educate injured workers and their employers.
- Worked in partnership with the injured worker and their employer to manage their journey in returning to work.
- Ensured timeframes and compliance measures are adhered to in line with legislation and company policy.
- Documented and applied decision-making principles.
- Met and worked in partnership with internal and external stakeholders to achieve best practice outcomes.
- Managed a mixed portfolio of end-to-end workers' compensation claims.
Experience
2-5 Years
Level
Executive
Education
Bachelor's Degree in Business
