Workers’ Compensation Case Manager

Job Overview: As a Workers’ Compensation Case Manager, you’ll play a pivotal role in supporting individuals who have suffered injuries at their workplace. Your primary objective will be to ensure that these workers receive the appropriate medical care, benefits, and support they need to recover and, when possible, return to work. This position requires a blend of healthcare knowledge, understanding of workers’ compensation laws, and exceptional interpersonal skills to navigate the complexities of each case effectively.

Key Responsibilities (Include But Are Not Limited To):

Client Service:

• Maintain regular communication with clients, keeping them informed about their case status, capturing detailed information about injuries, symptoms, treatments, loss of earnings, and disability status. 
• Utilize Smart Advocate for documenting all client interactions under the specific note topic “Client Contact.” 
• Maintain 90% Client Contact every 30 days
• Provide written and verbal notifications to clients for all required appearances and follow up with reminders.

File Management:

• Complete/file any and all necessary documentation on EAMS.
• Conduct file reviews every 45 days, updating as new information becomes available.
• Add defendant insurers to the “All Insurance” tab and request medical records promptly.
• Prepare medical summaries, chronologies, ratings, AME’s, case reviews, deposition prep, objection letters, PQME’s , and calculate Temporary Total Disability (TTD) payments as needed.
• Schedule reminders for client appointments, confirming with the client two days prior.
• Ensure Tasks an Workplans are current/completed. 
• Ensure files are current, with all records updated and complete for attorney review before hearings or meetings.
• Maintain, update, rename, and sort mail. Identify and escalate time sensitive documents. 
• File Declarations of Readiness to Proceed (DORs) timely based on specific criteria.
• Other duties as required. 

Settlement:

• Follow up on Compromise & Release (C&R) or Stipulations with Request for Award (SA) documents from adjusters or defense after settlements.
• Review settlement documents for accuracy, unusual language, and ensure all fees have been paid.
• Coordinate with your attorney for document review and client meetings.
• Follow up with the adjuster/defense for payment and confirm receipt with clients.
• Close files through accounting once all procedures are completed and payment is confirmed.