PURPOSE OF POSITION:

Works with appropriate stakeholders to maintain responsibility for the Cape Cod Healthcare (CCHC) workers' compensation (WC) program focusing on claims, case, and reserve management as well as data analysis and collaboration for preventive programs. Collaborates with the CCHC team, employees, managers, providers, attorneys, claims adjusters, workers' compensation third party administrator (TPA) and Human Resources colleagues to plan, implement and evaluate plans of care for CCHC employees who are on Workers' Compensation. Provides support, direction, and oversight of the CCHC Occupational Health Services (OHS) Team ensuring compliance

PRIMARY DUTIES AND RESPONSIBILITIES:

• Maintain clear focus on mitigating CCHC’s financial risk associated with occupational injuries and workers’ compensation claims
• Facilitate strong relationships between CCHC and strategic partners at all levels of these companies
• Understand and articulate the company’s business objectives internally and with strategic partners (such as the TPA)
• Develop a WC policy manual documenting end-to-end WC processes and procedures
• Provide oversight of procedures related to the CCHC internal clinical management of workplace injuries
• Bring focus, consistency, and continuous improvement to claims management and OHS in support of CCHC’s objectives
• Establish claim related KPIs that support CCHC goals/objectives
• Ensure successful implementation of claim policies, practices, and procedures internally and with strategic partners (including the TPA)
• Define strategies and best practice for effective utilization and continuous improvement of internal and external resources, including the TPA, defense counsel and experts.
• Through use of data, review selected claims and collaborate with Occupational Health and the TPA on moving cases to resolution efficiently and cost effectively.
• Establish reserve and settlement philosophy in conjunction with internal partners, review reserve and settlement requests
• Work closely with the TPA on report design and trend analysis
• Identify outlier trends: Focus on areas where the movement is beyond the expected volatility indicating an underlying shift in the claims experience.
• Identify issues that may be driving the above-mentioned trends: conduct appropriate analysis of adverse trends.
• Refresh and maintain effective RTW policies and procedures; provide oversight of RTW program
• Collaborate with CCHC colleagues on safety mitigation through use of historical claim data to determine where and why losses occur.
• Assist with and provide direction to OHS Team for OSHA record keeping; work closely with the TPA to improve data quality and reporting.
• Oversees CCHC OHS initiatives related to employee health including but not limited to: vaccination clinics, RTW clearance, new hire clearance, OHS policies and procedures and OHS systems operations.
• Consistently provides service excellence to all patients, family members, visitors, volunteers, and co-workers.
• Challenges current working practices; identifies process improvement opportunities and presents recommendations and solutions to management. Engages and commits to the organization’s culture of continuous improvement by actively participating, supporting, and promoting CCHC Pillars of Excellence.

EDUCATION/EXPERIENCE/TRAINING:

• Bachelor’s degree in a related field or equivalent combination of education and experience
• Licensed as a Nurse Practitioner or Physician Assistant in the Commonwealth of Massachusetts
• Knowledge of principles for providing customer services that meet quality standards.
• Exceptional communication, verbal, and written skills
• Must be able to communicate information clearly and accurately so that others understand.
• Five years related experiences in workers' compensation claim management with ability to manage a wide range of customer issues.
• Familiarity with Massachusetts Workers' Compensation Laws and Family and Medical Leave Act of 1993 (FMLA) and the Massachusetts Paid Family Medical Leave (MAPFML).
• Extensive knowledge of Workers’ Compensation and disability insurance administration laws and procedures
• Strong knowledge of Workers' Compensation claims management including settlement negotiations, utilization review, and loss management
• Managerial experience required with strong internal and external relationship management skills