Every employer is assigned a team consisting of a Medical Case Manager and a Claims Specialist to medically manage their claims.
The Medical Case Manager (MCM) is a Registered Nurse. The MCM manages all Lost Time claims and communicates, coordinates and collaborates with all parties: injured worker, employer, physician of record and BWC. The MCM reviews all treatment requests, approves/denies as appropriate and coordinates treatment so the injured worker receives the appropriate care in a timely manner. The Medical Case Manager works with the Physician of Record to identify any restrictions or barriers to Return to Work and obtains the Release to Work. The MCM coordinates with the employer to ensure a safe and timely return to work.
The Claims Specialist (CS) works with the Medical Case Manager and is responsible for filing the claim; gathering information and documentation; sharing the information with all parties and monitoring the injured worker on light duty/transitional work. The CS works closely with the Medical Case Manager to achieve a full-duty return to work. The Claims Specialist is responsible for managing most of the Medical Only claims.
The Regional Manager is assigned to employers to serve as the workers’ compensation resource. The Regional Manager provides reports, reviews trends and recommends programs and strategies that can reduce claims and/or costs. The Regional Manager coordinates staffing meetings between the Medical Case Manager, BWC and TPA. The Regional Manager educates employers about available return-to-work services, BWC safety programs and cost-saving strategies and programs.