We’re looking for motivated, engaged people to help make everyone’s journeys better.

Medically investigate and manage Workers’ Compensation (WC) claims, medically complex employment and return to work requests, and acts as a liaison between employees, management, insurance, medical providers, and outside legal counsel to ensure injured workers receive the best care possible while protecting the interests of the company. Provides strategic oversight, case management, and data analysis of all WC cases to identify efficiencies, trends causing barriers to claim closure, risks of fraud, and other trends in order to research and resolve in the most efficient and beneficial ways."

Benefits

Paid time off401k, with company matchCompany sponsored life insuranceMedical, dental, vision plansVoluntary short-term/long-term disability insuranceVoluntary life, accident, and hospital plansEmployee Assistance ProgramCommuter benefitsEmployee Discounts

Main Duties and Responsibilities:

• Review and analyze all reported On the Job injuries prior to submission to the WC insurer in order to identify cases requiring medical investigation and complex case management
• Create and implement investigation and case management plans for complex WC claims, and develop strategies for guidance and communication to claims administrators, insurers, legal counsel and others
• Provides guidance, claims management strategy, and legal strategy to WC claims administrators
• Review and manage medically complex cases, such as requests for modified duties or FMLA Leaves, referred by HR and managers
• Partners with insurance, healthcare providers, EHS, unit management, and HR to establish good working relationships and effectively manage complex claims
• Provides oversight and strategic direction to insurance, healthcare providers, and outside counsel to ensure adherence to applicable laws, company policy, and ethical standards
• Oversees return to work program as a tool to promote injured workers’ recovery and manage costs, counseling managers and employees dealing with challenging situations, medical, and return to work issues
• Works with and provides training to field HR to ensure FMLA, LOA and other tracking is timely, accurate, and up to date
• Fields questions from around region, occasionally during off hours
• Monitors and reviews investigation reports and WC case folder paperwork for region
• Establishes and maintains protocols to manage transitional duty, lost time, open claims, and other aspects of the program
• Actively seeks cost-saving measures by ensuring injured workers are treated with respect, compassion, and consistency, and through timely and aggressive claims management
• Collects and analyzes data for use in safety and incentive programs in support of injury reduction and continued safety awareness and education
• Ensures consistent unit compliance with company policies and procedures
• Monitors, reviews, and provides recommendations to Corporate Risk Manager concerning reserves for claims
• Reviews the monthly allocation charges with unit mangers and controllers to explain charges, discuss potential charges for forecasting purposes, and identify possible appeals
• Investigates and pursues denials on claims with questionable compensability
• Reviews region’s OSHA logs monthly to ensure compliance
• Ensures BLS surveys and yearly OHSA Logs are posted as required, and all records are retained in compliance with local, state, and federal laws
• Participates in required meetings, including: Incident Review Boards, Claims Reviews, Regional Meetings, PRIDE, and others upon request
• Participates in on-going education to ensure current information on applicable laws, industry trends, and innovative approaches
• Occasional travel to Toronto and other units will be required for business and investigative purposes

Core Competencies and Requirements

Education
• Associate or bachelor’s degree in a nursing or physical therapy field

Work Experience
• At least five (5) years of progressively responsible professional experience in Workers’ Compensation, Short-Term Disability or Long-term Disability claims and case management, with at least three (3) of those years including complex case management, investigation, and collaboration with Legal counsel on recommendations and resolutions.
• Experience working with diverse populations
• Experience working in high stress, time sensitive environments

Technical Skills
• Medical certification, license or registration in good standing with the governing body of the field of study and practice
• Strong medical and appeal claims management skills
• Solid decision making and creative problem-solving skills
• Ability to work calmly with individuals in highly emotional states
• Strong interpersonal skills and ability to work in a team
• Self-starter requiring little supervision

Core Competencies Required
• Strong analytical, organizational, and investigative skills
• Strong business and financial acumen to support program strategy and efficiencies
• Strong verbal and written skills
• Flexibility and responsiveness
• Good follow-through and sense of accountability
• Detail oriented
• Solid computer skills, including advanced MS Office knowledge and ability to learn claims management program
• OSHA 10 hours certification a plus

We anticipate that this job will close on:

08/10/2025

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