Position Classification Title: Worker's Comp Specialist
Position Classification Code: L1023
Job Family: Human Resources
Pay Level: 07
Exempt Status: Exempt
This description is intended to describe the general nature of the work being performed. It is not intended to be a complete list of specific duties of any particular position. Duties, responsibilities and bargaining unit eligibility may vary based on the specific tasks assigned to the position.
Purpose of Classification:
Under indirect supervision administers the University's workers compensation program. Investigates, and makes decisions regarding compensability and appropriateness of claims. Processes and documents workers claims, ensuring compliance with relevant policies, procedures, and legislation. Acts as the University's authority on workers compensation policies and legislative provisions. Provides liaison with and advisement to external agencies and regulatory bodies in claims administration and in the care and disposition of claimants.
Standard Duties:
Evaluates all work-related accident reports for completeness and clarity of data; analyzes data to ensure compliance with policy and regulatory requirements. Investigates claims for eligibility and determines appropriateness and amount of worker's compensation claims; Ensures that claims processing meets legal and procedural requirements resulting in proper and timely payment to employees and medical providers. Assembles appropriate medical information and facts regarding claims for cases pending litigation; May represent the university at Workers' Compensation Administration mediation,formal hearings and trials. Advises University staff on and interprets loss and worker's compensation policies, procedures, legislation,and regulations;designs and implements training and orientation programs for the university community.Coordinates and participates in strategic planning aimed at reducing the incidence of worker's compensation-related injuries. Makes strategic recommendations for reducing the frequency and severity of losses through the use of a worker's compensation database and claims reports; Communicates and interacts with medical professionals, support agencies and others to monitor and assess the progress of rehabilitation efforts, to facilitate either return to work or, depending upon medical status of the claimant, placement into appropriate alternative positions within or outside the University, ensuring compliance with all appropriate regulations and guidelines.Prepares all necessary forms, records and documentation, to include statistical analyses and reports, for all claims assigned, as required by various regulatory agencies. Designs and develops data bases, performs integrated data analyses, and prepares reports. Handles and processes casualty and property liability claims in the absence of the Mgr, Insurance and Claims. Performs miscellaneous job-related duties as assigned.
Knowledge, Skills and Abilities:
Knowledge of process requirements of administrative hearings and litigation. Knowledge of data management systems and processes. Knowledge of property and liability claims legislation, regulations, policies, processes, and procedures. Knowledge of applicable legislation, standards, policies and procedures within specialty area.
Strong interpersonal and communication skills and the ability to work effectively with a wide range of constituencies in a diverse community. Records maintenance skills. Skill in examining and re-engineering operations and procedures, formulating policy, and developing and implementing new strategies and procedures. Conflict resolution and/or mediation skills. Skill in conducting accident investigations. Skill in developing and implementing return-to-work, modified duty programs.
Ability to use independent judgment and to manage and impart confidential information. Ability to use independent judgment and make appropriate insurance claims adjustment decisions and determinations. Ability to document work in progress. Ability to provide legal depositions and testimony. Ability to communicate technical information to non-technical personnel. Ability to investigate and analyze claims information and to draw conclusions.
Minimum Qualifications:
   Education- Bachelor's degree in a related field.
   Experience- Three (3) years of experience related to the standard duties as outlined.
   Equivalency- None
   Departmental Requirements-
   Special Requirements-