Workers' Compensation Program and Claims Manager

denverhealth; Denver (CO); On-site; USD 120,000 - 170,000; Full time

Job summary

Denver Health is seeking a Workers' Compensation and Claims Manager to oversee the administration of the health system's workers' compensation program and related claims. You will serve as SME for workers' compensation, coordinate with TPAs, carriers, and internal partners, and drive risk reduction, cost containment, and program improvement.

You will work with EMS, property claims oversight, and support in-house legal on various claims matters, ensuring compliance and effective claims handling

Qualifications

• Experience leading workers' compensation programs and claims management.
• Knowledge of return-to-work processes and regulatory compliance.
• Strong collaboration with HR, Legal, Risk Management and external vendors.

Responsibilities

• Oversee self-insured workers' compensation program from injury through closure.
• Coordinate with third-party administrator and carriers to ensure timely claim progression.
• Develop policies, training materials and loss prevention initiatives with stakeholders.
• Manage property claims, safety and loss-prevention activities across the health system.
• Support EPL and other claims and assist in investigations and settlement processes.

Job description

Our Values

Respect | Belonging | Accountability | Transparency

Department

Risk Management

Job Summary

Under minimum supervision, the Workers' Compensation and Claims Manager oversees the administration and day-to-day operations of the health system's workers' compensation program, managing claims alongside the third-party administrator from the initial report of injury through final resolution. Serving as a subject matter expert for workers' compensation and return-to-work matters, the incumbent ensures compliance with applicable laws, regulations, and organizational policies while serving as the primary liaison among injured employees, managers, HR, Legal, Risk Management, medical providers, insurance carriers, third-party administrators (TPAs), and other external partners. The position is responsible for effective claims management, employee support, risk reduction, cost containment, safety and loss prevention, and continuous program improvement. In addition, this role works closely with Emergency Medical Services (EMS) and oversees property claims throughout the health system, coordinating with facilities, engineering, and insurance. This position supports in-house legal counsel with other claims, including employment and auto claims.

Essential Functions :

Workers' Compensation Program Administration

• Under indirect supervision, coordinates, administers, and oversees all phases of the self-insured workers' compensation program from the initial report of injury through claim closure. Works directly in claims management software including ICE.
• Reviews initial injury report and coordinates reporting system technologies, including the Denver Health "OUCH" line and the occupational health clinic.
• Serves as primary point of contact for injured employees including lost time inquiries and workers' compensation payroll matters.
• Coordinates with insurance carriers, Third Party Administrator, and occupational health clinic to facilitate timely claim progression.
• Administers and coordinates return-to-work and modified duty programs in partnership with employees, managers, and Leave of Absence office.
• Ensures compliance with workers' compensation laws, regulations, and reporting requirements.
• Develops policies, procedures, training materials, and loss prevention initiatives through strategic partnerships with key stakeholders.
• Provides education and guidance to departments regarding potential exposure, mitigating risk, and safety provisions, including the implementation of such.
• Analyzes claims, loss statistics, and injury trends to identify risk exposures, prevention opportunities, program trends, and cost-reduction strategies.
• Manages claim-related vendors and external partners, monitors carrier and TPA performance, addresses service issues, and reports claims to excess carriers when applicable.
• Maintains accurate and confidential claim records and documentation, including generating accurate reports and claims data from the claims management system for purposes of insurance, safety and finances.
• Obtains certificates of insurance upon request.

(50%)

Property Claims Management

• Manages the health care system's property claims and incidents.
• Facilitates and assists with property inspections by the property carrier.
• Maintains a real property inventory and valuation and provides changes to the broker.
• Coordinates investigations with facilities, engineering, carriers, and brokers to respond, report, and manage system response to property damage.
• Reports claims to the insurance company per policy requirements.
• Generates detailed reports on property losses and claims history as requested.

(20%)

Safety and Loss Prevention

• Develops and implements new approaches to loss prevention, safety and control.
• Evaluates area of loss and implements/coordinates corrective actions.
• Partner with the Director of Safety and Environment of Care and other key stakeholders to mitigate potential safety and hazardous concerns.

(10%)

Other Claims Management

• Assists in managing commercial automobile, general liability, and other assigned claims.
• Coordinates with insurers, attorneys, adjusters, and stakeholders as needed.
• Conducts investigations and analyzes liability and exposure.
• Supports settlement, mediation, and litigation management.

(10%)

Employment Practices Liability (EPL) claim support

• Supports in-house legal counsel in employment-related claims, including intake of new EPL claims and opening and closing files in the claims management system.
• Reports the claim to the EPL carrier and generates a legal hold if applicable. Supports claim management as needed, including updating the claims management system, sending engagement le