Facility

Cape Fear Valley Medical Center

Location

Fayetteville, North Carolina

Department

Risk Management

Job Family

Clerical

Work Shift

Days (United States of America)

Summary

Work in collaboration with Workers Compensation Manager to process workers’ compensation claims for the health system. Position requires high level of communication and analytical skills, particularly in dealing with sensitive and confidential information regarding workers’ compensation claims. Investigate employee injury events, conduct interviews, and file required documentation with governing State agencies, manage and maintain assigned workers' compensation claims, daily diary events and database tracking. Responsible for approval of all levels of workers' compensation claims. Review and verify payments for services provided and disability amounts in conjunction with the workers' compensation program and individual claims.

Major Job Functions

The following is a summary of the major essential functions of this job.  The incumbent may perform other duties, both major and minor, that are not mentioned below.  In addition, specific functions may change from time to time:

• Investigate and analyze data to determine compensability in accordance with the NC Workers’ Compensation Act

• Manages assigned workers' compensation claims in a timely manner

• Attend workers' compensation mediations and NC Industrial Commission hearings as required

• Independently works within certain limits and authority to actively manage a caseload of complex lost time cases

• Establish claim reserves, propose and negotiate settlements under the supervision of the Workers’ Compensation Program Manager

• Approve disability and medical payments and other expenses related to workers' compensation claims

• Review employee incident report to determine which employee injury/illness incidents meet OSHA recordability criteria and documents individual files in database accordingly

• Prepares NC Industrial Commission forms and dispatches them to responsible parties

• Collect, enter, and update information in workers' compensation software database

• Maintain claims diary and completes diary items in timely manner

• Review and verify bills for services provided in conjunction with workers' compensation program and individual claims

• Authorize check requests for workers' compensation benefits, medical payments, case management bills, settlement checks in addition to other miscellaneous expenses

• Assist with preparation for workers' compensation legal proceedings

• Keeps current with laws and regulatory requirements related to workers' compensation and OSHA to assist the Health System in maintaining compliance with same

• Maintain strict confidentiality of all documentation, information, and work-product

• Other duties as assigned

Minimum Qualifications

The following qualifications, or equivalents, are the minimum requirements necessary to perform the essential functions of this job:

Education and Formal Training: 

• Associate’s degree in business or a related field is required

• Bachelor’s degree preferred

• Current North Carolina Claims Adjuster's License and in good standing required

• Valid North Carolina driver’s license required

Work Experience: 

• 4 years’ experience in workers' compensation claims administration required

• 3 years’ of experience in safety, legal, and insurance environment preferred

Knowledge, Skills, and Abilities Required: 

• Proficiency in reading, writing, and speaking the English language

• Knowledge of North Carolina workers' compensation law

• Understanding of litigation processes and importance of documentation

• Knowledge of OSHA regulations

• Ability to work with people in a professional, tactful, and diplomatic way

• Ability to work independently and accomplish tasks in timely manner

• Ability to organize and prioritize activities and tailor procedures to a smoothly functioning department

• Ability to work with variety of changing activities from entering data into computer database to making highly technical decisions

• Ability to hold in confidence highly sensitive information and materials

• Proficiency with Microsoft Office software (e.g., Outlook, Word, Excel, etc.)

• Proficiency with the use of a claims database, e.g., iVOS or another insurance carrier’s database

Physical Requirements: 

• Ability to move throughout the hospital system facilities

• Reaching, handling, and finger dexterity to operate office machines

• Walking and ability to climb for investigating incidents sites throughout the hospital system facilities

• Ability to drive is needed to investigate off-campus incident sites

• Talking and hearing is essential for communicating with others and conducting interviews

• Manual dexterity is needed for manipulating equipment and handling tools

• Visual acuity for inspection of equipment and Health System environs in conjunction with incident investigations, reviewing data and reports

• Ability to lift up to 20 pounds

Required Licenses and Certifications

Cape Fear Valley Health System is an Equal Opportunity Employer M/F/Disability/Veteran/Sexual Orientation/Gender Identity