Eligibility Case Manager
Core
Assessing and determining eligibility for workers' compensation claims in a self-insured environment, including initial liability decisions and compensation calculations.
Role type
Eligibility Case Manager (Workers' Compensation)
Builds
Initial claim determinations and compensation entitlements for injured workers
Domain
Insurance / Workers' Compensation
Deliverable
client delivery
Required skills
Workers' compensation case management, claim eligibility assessment, liability determination, Pre-Injury Average Weekly Earnings (PIAWE) calculation review, claims investigation, stakeholder liaison
Preferred skills
Health or business-related qualification, experience in self-insured environments
Technologies
Assure, Microsoft Office Suite
Responsibilities
Assess new workers' compensation claims to determine eligibility based on legislation and guidelines; Conduct investigations into claims with unclear liability; Review and approve initial PIAWE and Weekly Compensation calculations; Coordinate transition of accepted claims to ongoing Case Managers; Liaise with payroll to verify earnings data; Communicate claim decisions to injured team members, employers, and stakeholders; Ensure compliance with workers' compensation legislation and self-insurance requirements; Maintain accurate claims data and documentation in Assure.
Seniority
Mid-level, hands-on IC
