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Claims Coordinator Orientation Information

KEY RESPONSIBILITIES OF A CLAIMS COORDINATOR:

  • A District Claims Coordinator acts as the liaison between certain District staff (as determined by District policy) and CCCSIG to ensure an immediate and direct line of communication for the administration of Workers' Compensation benefits and associated claims cost containment activities.
  • Assists with district-wide communications for telephonic claims reporting through Company Nurse for new Supervisors (training and materials) and Employees (materials)
  • Assists with the reporting of new claims to Company Nurse in lieu of a supervisor or manager if necessary
  • Assists in providing payroll, personnel and general claims information to the CCCSIG Claims staff assigned to the claim
  • Receives and provides medical information to CCCSIG Claims staff, as available to them
  • Working in conjunction with CCCSIG Return to Work Specialist, is responsible for placing employees into Temporary Work Assignments (TWA) or Modified Duty after each medical visit
  • Assists CCCSIG in obtaining signatures/authorization of District HR Managers on required forms pertaining to permanent modified/alternate work assignments
  • Participates in the district claims review meetings and in many cases reports results to designated district staff
  • Ensures CCCSIG has current district information including contact and site data to pass on to Company Nurse
  • Receives/orders updated workers' compensation materials (medical panels, pamphlets, posters, etc.) and distributes, as appropriate
  • Attends countywide Claims Coordinator meetings and training sessions at CCCSIG, usually once a year
  • Emails the Accident Investigation Form (included in the Company Nurse Report email) to the manager of the injured employee (see Accident Investigation Form Best Practices and Prevention Recommendations for Accident Investigation Form Emails to Managers).

 

CLAIMS COORDINATOR ORIENTATION MATERIALS

Overview of Programs:

Company Nurse

The Role of our Triage Nurses

District Medical Panel listing

Pharmacy Benefit Management Program


Accident Investigation Form Emails

Accident Investigation Form Best Practice

Prevention Recommendations for Accident Investigation Form Emails to Managers


Return-to-Work Program

RTW Guidelines

RTW Process for Claims Coordinator

RTW Process for Injured Employee

RTW on Day of Injury for Claims Coordinator

Temporary Work Agreement

Pre-Designated Temporary Work Assignments

RTW Process for Injured Employees Flyer

 

Utilization Review & ACOEM

Description of Employee's Job Duties Form 10133.33

Utilization Review FAQ's answered by the State

 

Overview of Self-Administration

Red Flags for Claims Investigation

CCCSIG Preferred Provider List

Statement of Personal Physician Designation & Pre-Designated Physician Form

Statement of Personal Physician Designation & Pre-Designated Physician Form (Spanish)

Statement of Personal Chiropractor or Personal Acupuncturist

Average Weekly Wage Flyer

WC Frequently Asked Questions

WC Glossary of Terms

 

Information Sources

CCCSIG Facts About Workers' Compensation

Medical Panel Posters

Sample Monthly Trend Report

Time of Hire Pamphlet

 

DISTRICT CLAIMS COORDINATORS

Acalanes Union High SD Janice Sullivan
Antioch USD Jessenia Hernandez
Brentwood Union SD Debbie Valladao
Byron SD Roxanne Felver
Canyon SD Gloria Faircloth
CCC College District Andrea Medina/Herb Lester
CCC Office of Education Marie Middleton
John Swett USD Tova Freels
Knightsen SD Jen Faris
Lafayette SD Brandy Hennefer
Liberty Union High SD Debbie Matteson/ Jean Kindt
Martinez USD Alex Birdsell
Moraga SD Christine Avellar
Oakley Union Elementary SD Maria Bordanaro /Tammi Lauderdale
Orinda Union SD Mary Brakefield
Pittsburg USD Christine Huston
San Ramon Valley USD Angelina Silva/Mary Garcia
Walnut Creek SD Joyce Larsen
West Contra Costa USD Fran Martz

 

For questions please contact Karen Hurd, Claims Manager.

     
 

2017 Legal Updates

Claims Coordinator Workshop Sept 2017