CompManagement Health Systems (CHS), a Sedgwick company, provides a full end- to-end managed care solution for state-funded employers and their injured workers within the state of Ohio. Our colleagues are here to simplify the process, helping bring employees back to work quickly and safely. With 30,000 clients, CHS contracts with the Ohio Bureau of Workers' Compensation for initial injury triage, telephonic and field case management, utilization review, alternative dispute resolution, bill review services, and account management.
PRIMARY PURPOSE: To gather claim data and manage low to mid-level workers compensation claims to full duty Return to work; facilitate appropriate treatment services efficiently, within required Ohio BWC Guidelines for compliance, company standards, industry best practices and/or client specific requirements to promote best outcomes.
ESSENTIAL FUNCTIONS and RESPONSIBILITIES
Obtains expected elements for subsequent EDI to the Bureau of Workers Compensation (BWC).
Manages medical-only and low- to mid-level lost-time workers compensation claims under close supervision.
Processes workers compensation claims reviewing receipt of compensation; Treatment plans; facilitating services; collaborating with all claim parties with updates and changes.
Verifies return to work documentation through telephonic and written communications and records return to work dates appropriately in system(s).
Manages claims in close collaboration with Claims Management Team.
Supports other claims management staff with larger or more complex claims as necessary.
Makes referral for case management and/or utilization management when work status changes due to functional limitations/medical instability.
Documents communications and claims management appropriately in system(s).
Responds to all inquiries within one (1) business day.
Maintains knowledge of BWC rules and laws, workers compensation process, and CHS policies and procedures.
Maintains professional client relationships
Meets and maintains productivity and quality expectations
ADDITIONAL FUNCTIONS and RESPONSIBILITIES
Performs other duties as assigned.
Supports the organization's quality program(s).
Education & Licensing
High School diploma or GED required.
One (1) year case management experience or equivalent combination of education and experience required.
Skills & Knowledge
Knowledge of BWC Mandatory and Expected EDI Transmission elements
Good oral and written communication skills
PC literate, including Microsoft Office products
Good organizational and time management skills
Good customer service skills
Ability to work independently and in a team environment
Ability to manage multiple and changing priorities
Decision making/problem solving skills
Ability to meet or exceed Performance Competencies
When applicable and appropriate, consideration will be given to reasonable accommodations.
Mental: Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines
Physical: Computer keyboarding, travel as required
Auditory/Visual: Hearing, vision and talking
The statements contained in this document are intended to describe the general nature and level of work being performed by a colleague assigned to this description. They are not intended to constitute a comprehensive list of functions, duties, or local variances. Management retains the discretion to add or to change the duties of the position at any time.
Sedgwick is an Equal Opportunity Employer
Sedgwick Claims Management Services, Inc.