Job Description:
About the role
As a Long Tail Case Manager responsible for managing claims beyond 78 weeks in workers' compensation, your role becomes more focused on ensuring ongoing support and reviewing the entitlements of injured workers. Here's how you can effectively manage these responsibilities:
Entitlement Determination : Beyond 78 weeks, you'll need to review whether injured workers are still entitled to weekly payments and ongoing medical expenses. This involves assessing medical reports, rehabilitation progress, and any vocational assessments to determine the worker's capacity to return to work.
Communication and Customer Service : Excellent communication is at the core of your role. You'll be the main point of contact for injured workers, employers, and healthcare providers. Clear, empathetic communication helps build trust and ensures all parties are informed about the claim status, treatment plans, and return to work expectations.
Coordination of Medical Treatment : You'll work closely with healthcare providers to ensure injured workers receive appropriate medical treatment. This may involve approving treatment plans, scheduling appointments, and monitoring progress to facilitate recovery.
Payment Processing : Timely processing of payments for medical treatment, disability benefits, and other expenses related to the claim is essential. Accuracy and efficiency in financial transactions demonstrate professionalism and support to injured workers during their recovery.
Case Conferences and Reviews : Participating in case conferences with stakeholders, including injured workers, employers, insurers, and legal representatives, helps in evaluating progress and making informed decisions about the claim.
Documentation and Compliance : Maintain accurate records of all interactions, decisions, and progress related to each claim. Ensure compliance with regulatory requirements and company policies to protect the interests of all parties involved.
Continuous Learning and Improvement : Stay updated with industry trends, legal changes, and best practices in workers' compensation case management. Continuous learning enhances your ability to provide effective support and navigate complex situations.
By focusing on these responsibilities with empathy, professionalism, and a commitment to excellence, you can effectively manage your portfolio of workers' compensation claims and support injured workers in their journey.
Required Skills and Qualifications:
Strong analytical and reasoning skills.
Ability to plan and organize work effectively to manage timeframes and priorities.
Experience working concurrently across multiple technology platforms.
High level of organizational skills and attention to detail.
Excellent written and interpersonal communication skills.
Ability to work effectively within a team in an office-based environment.
Exceptional customer service skills with a focus on delivering high-quality outcomes.
Sensitivity to issues related to people with medical, cultural, and social needs.
Australian Citizenship or Permanent Residency required.
Preferred Qualifications:
Previous experience in workers' compensation case management or a related field.
Knowledge of workers' compensation legislation and regulatory requirements.
Relevant qualifications in allied health, social work, or a related discipline.
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