Ambulance Victoria Position Description

Transcription

1 Ambulance Victoria Position Description Position Title: Claims Management Coordinator Reports To: Injury & Claims Management Team Leader Division: People & Community Department: Health, Safety & Wellbeing Direct Reports: Nil Employment Conditions: Metropolitan Ambulance Service and Health Services Union (Management and Administrative Staff) Collective Agreement 2006 OR Rural Ambulance Victoria and Health Services Union (Management and Administrative Staff) Collective Agreement 2006 (as applicable) Primary Objective: Coordinate and implement the day-to-day administration of all AV WorkCover claims in accordance with the Accident Compensation Act 1985, ensuring the effective ongoing management of an injured employee s claim. This position is also responsible for providing advice to line managers and employees on the workers compensation process, making recommendations regarding ongoing Workers Compensations management principles and strategies, and ensuring a proactive claims management plan is in place for all claims in collaboration with AV s Rehabilitation Advisors and Authorised WorkSafe Agent. Responsibility for Quality: To take responsibility for improving quality processes using continuous improvement philosophies and practices, thereby increasing value to the customers and the organisation Behaviours Achievement Self-Actualising Humanistic-Encouraging Affiliative Achieves self set goals Believes that individual effort is important Receptive to change Encourages growth and development in others Cooperative Creative problem solver Resolves conflicts constructively Friendly Accepts and shares responsibility Non-defensive Trustworthy Genuine in concern for others Takes on challenging tasks Self respecting Involves others in decision making Accepts change Insightful in diagnosing problems Motivates by serving as a role model Page 1 of 7

2 Position Scope Budget: Nil Financial Delegation: Nil Occupational Health & Safety Understand, observe and adhere to all safe working procedures and maintain safe work practices Provide and promote an occupational environment that is responsive to the health, safety and welfare needs of employees, contractors and the general public Equal Employment Opportunity Understand, support and adhere to the principles covered in the AV Workplace Respect Policy Key Contacts Internal Rehabilitation Advisors, WorkCover Policy Advisor, Injury & Claims Management Team Leader, Finance, Payroll, Human Resources Partners, OHS Advisors, and AV Managers and Employees External AV Authorised WorkSafe Agent, Medical Practitioners, Solicitors, Government Agencies, WorkCover Conciliation, WorkSafe Victoria, ALHMU - Ambulance Section, Health Services Union of Australia Page 2 of 7

3 Key Accountabilities Key result area Key Accountabilities Claims Management Initiate and maintain contact with injured employees and all other parties associated with the claim Claims Administration & Premium Management Work closely with the Rehabilitation Advisors and AV s WorkSafe Agent in relation to initial determination of liability and seek further technical advice from the WorkCover Policy Advisor where required Ensure identification of any high risk claims that are likely to lead to delays in or have potential for no return to work (RTW) outcome are triaged in collaboration with the Rehabilitation Advisor, including all stress/psychological claims Maintain appropriate and consistent records of claims correspondence and other documentation/information in individual claim files Work closely with injured employees, line managers, Rehabilitation Advisors, Human Resources Partners and AV s Authorised WorkSafe Agent to ensure sustainable RTW outcomes and minimise impact on AV s premium In collaboration with the Injury & Claims Management Team, AV s Authorised WorkSafe Agent and other stakeholders, develop strategic, proactive claims management plans aimed at achieving timely, sustainable RTW outcomes for injured employees and minimising premium impact, and present these plans at regular internal and external claims reviews in conjunction with the allocated Rehabilitation Advisor Liaise with AV s Authorised WorkSafe Agent in relation to claims management strategies including the coordination and timely receipt of independent medical examinations, vocational assessments, new employee services, treaters report and other documentation/information as required as part of the claims management process and report back to the Injury & Claims Management Team Sort and process all aspects of workers compensation claims including calculating and processing payments (medical invoices and weekly earnings), calculating and administering make-up pay periods in alignment with the relevant Award and processing impairment benefit applications Ensure new claims and medical certificates are supplied to AV s Rehabilitation Advisors in a timely manner and processed in accordance with AV s legal obligations Calculate and provide Pre-Injury Average Weekly Earnings (PIAWE) to the Agent to ensure accurate weekly compensation payments Ensure changes to entitlements are communicated verbally and in writing to the injured employee prior to implementation Input all appropriate claims information into computerised databases/systems, ensuring currency, accuracy and confidentiality in accordance with AV policy, the Accident Compensation Act and other relevant legislation Liaise with AV s Authorised WorkSafe Agent in relation to provision of claims, medical certificates, accounts, reimbursements and reconciliations, and ensure the correct reconciliation of compensation payments and reimbursements In collaboration with Payroll, the Injury & Claims Management Team and AV s WorkSafe Authorised Agent, process WorkCover payments and adjustments, including reviewing, cross checking and approving data on timesheets and other computerised databases/systems when compared to claims details and status including certificates, days/hours worked Page 3 of 7

4 Key Accountabilities Key result area Key Accountabilities Assist in the coordination of the circumstantial investigation process and provide documentation to investigators as required Assist with the administration of Premium calculation/payment function to ensure premium is accurately calculated/reported Perform routine duties such as WorkCover mail collection, processing, distribution and filing Ensure records are archived when required in accordance with AV guidelines Early Intervention Provide initial advice on the principles and practice of early intervention in alignment with AV s procedures Make referrals to Rehabilitation Advisors, OHS Advisors, Peer Support, Health & Fitness Advisor and/or others for additional support services and/or specialist advice Stakeholder Management Liaise with WorkSafe Victoria and AV s Authorised WorkSafe Agent to maintain an effective working relationship and ensure proactive claims management activities are provided Ensure WorkCover establishment information is updated and centrally registered, advising WorkSafe Victoria of any changes (i.e. registration of workplaces) Provide advice and make recommendations to the Injury & Claims Management Team Leader regarding the service level agreement with AV s Authorised WorkSafe and WorkCover Agent and performance against this agreement Coordinate the tender process as required to ensure the best claims management service provision for AV Records & Reporting Conduct regular internal and external reviews of claims and contribute to reports and recommendations on claims management strategies, information, trends and premium reduction to the Injury & Claims Management Team Leader and Manager Health, Safety and Wellbeing Training, Education & Advice Develop reconciliation spreadsheet reports on any discrepancies between compensation amounts paid and received and ensure discrepancies are clarified and corrected Compile regular and ad-hoc statistical, financial and analytical reports/recommendations/trends for submission to the Manager Health, Safety and Wellbeing, OHS Committee and AV Executive Contribute to the Health, Safety & Wellbeing newsletter or other appropriate publications on a regular basis Contribute to and assist with the execution of various education and training packages to improve overall understanding of WorkCover management processes across the organisation Provide on-the-job training, education and advice to line managers and injured employees on workers compensation service provision to ensure compliance with legislative standards and organisational requirements Participate in various meetings relating to case reviews, case conferences, workplace assessments, conciliation, rehabilitation, court actions and union issues as required Provide input into the development, implementation and review of AV s Injury & Claims Management policy and procedures to ensure they are up-to-date and continue to meet program and legislative requirements Page 4 of 7

5 Key Accountabilities Key result area Dispute resolution & court proceedings Key Accountabilities Refer all grievances and complaints in line with AV grievance and complaint handling procedures to minimise negative effects on employees and the organisation s operations Provide support and advice in relation to the dispute resolution process surrounding claims for compensation in alignment with AV procedures Liaise with the Injury & Claims Management Team in relation to up and coming conciliation meetings and determine the most appropriate AV representative to attend Liaise with AV s WorkCover Policy Advisor where injured employees are seeking advice in relation to eligibility and process for assessing and seeking impairment benefits and support the coordination of relevant claims management documentation for AV s response to serious injury applications and associated court proceedings where required Page 5 of 7

6 Selection Criteria Qualifications and experience Appropriate short-course or degree qualification in WorkCover Management, Occupational Health & Safety or other related discipline Thorough knowledge of workers compensation legislation, practice and trends and experience in its practical application, along with insurer requirements Extensive experience in premium and WorkCover claims management, administration and processing Sound knowledge of relevant ethical protocols, legal considerations, medical terminology and confidentiality in accordance with the provision of the Accident Compensation Act 1985 and Freedom of Information Act 1982 Experience with legal issues and settlements and knowledge of Freedom of Information legislation including collaborating with solicitors, unions and government agencies Proven experience in using computerised claims management, financial and management information systems, including Microsoft Word, Excel and Access Current Victorian Driver s License Key attributes Verbal communication skills to enable the conveying of accurate, clear and concise ideas and information which is appropriate for the target audience Written communication skills to prepare a range of documents including correspondence and reports which are clear, concise and accurate and which use language appropriate for the target audience Well developed interpersonal and influencing skills, with strengths in consultation, negotiation and conflict resolution, to gain acceptance and support of ideas and cooperation from all levels, provide professional leadership and support to managers and employees in achieving objectives, and the ability to modify style to accommodate situations, tasks and individuals Ability to train and/or educate others in WorkCover practices, systems and processes Relationship building skills to take appropriate action to develop strong and collaborative relationships with internal and external stakeholders Planning, organising and time management skills to prioritise tasks, manage personal workload and conflicting demands in a busy environment to achieve outcomes within required timeframes, with an ability to maintain stable performance and display resilience whilst under pressure Well developed conceptual, analytical and problem solving skills to enable the identification of issues and the judgement to determine appropriate courses of action to resolve problems and achieve goals Ability to contribute to a positive team environment, work effectively as part of a team and assist others to meet their objectives Strong customer service orientation to take responsibility for understanding client needs and ensuring these are met, including the ability to translate, challenge and manage customer requests Attention to detail through showing concern for all aspects of the job using appropriate checking processes to ensure accuracy Initiative to identify and follow up on potential opportunities and risks within AV s WorkCover processes and practices High level of integrity, discretion and diplomacy to ensure compliance with relevant legislation and maintain confidentiality around sensitive issues Willingness to travel throughout Metropolitan Region and Regional Victoria as required Page 6 of 7

7 Desirable Certificate IV in Training & Assessment Approval Manager: Health, Safety & Wellbeing General Manager: People & Community Page 7 of 7