Workers' Compensation Specialist

Summary

Performs the full range of professional duties required to administer and oversee the workers' compensation program, including the performance of complex and/or sensitive claims activities; provides guidance on claims administration, medical case management, and return-to-work coordination; monitors legislative compliance and third-party administrator performance; recommends and implements changes in program practices, workflows, policies, and procedures; audits claims and analyzes program data to support regulatory filings and fiscal performance; participates in procurement and contract administration; collaborates with internal and external partners to resolve complex claims issues; provides guidance and professional development to staff; may manage large-scale, long-term projects.

Qualifications

Required

• Any combination of education and experience equivalent to a bachelor's degree in business administration, finance, human resources or related fields.
• Four (4) years of experience in claims administration, benefits administration, human resources, financial services, or related experience.
  • Advanced degree(s) beyond the minimum degree requirement in a relevant field may be considered for some experience.
• Knowledge of the theory, procedures, and practices of claims administration.
• Knowledge of federal and state employment laws related to workers compensation, disability management, and leave programs (e.g., FMLA, ADA, and OSHA).
• Proficiency in the use of technology and data compilation, analysis, and reporting.
• Ability to provide subject matter expert advice on complex issues.
• Ability to lead and facilitate discussions to resolve conflicts.
• Ability to interpret, assess, and recommend modifications to procedures, regulations, and legislation.
• Ability to analyze, interpret, and evaluate financial and administrative data to develop and generate reports for program performance, mandated filing requirements, and/or fiscal decision-making.
• Ability to review, analyze, and evaluate the contractual specifications of bids and proposals.
• Ability to establish and maintain successful collaborative working relationships with diverse personnel and outside vendors to address needs and ensure that programs meet goals.
• Ability to exercise sound judgement, discretion, and professionalism.
• Ability to communicate effectively, both orally and in writing.

Preferred

• Any insurance, risk management; benefits or human resources certifications such as:
  • Associate in Claims (AIC)
  • Certified Workers' Compensation Professional (CWCP)
  • Associate in Risk Management (ARM)
  • Certified Risk Manager (CRM)
  • SHRM-CP or SHRM-SCP
  • PHR or SPHR
  • Certified Employee Benefits Specialist (CEBS)
  • Workers' Compensation Claims Professional (WCCP) or similar industry certifications
• Knowledge of project management and continuous process improvement methodologies.
• Ability to build productive relationships with internal leadership, legal counsel, medical providers, TPAs, and external agencies.
• Knowledge of benefits administration and HR policies.
• Knowledge of procurement, contact administration, and service level agreements (SLAs).
• Knowledge of budgeting, financial reporting, claims analytics, and cost containment strategies.

Major Duties/Essential Functions

1. Performs activities related to the administration and management of the division-wide workers' compensation program.
2. Responsible for workers' compensation claims administration, including medical case management, return-to-work coordination, and disability management activities.
3. Documents and resolve complex and/or sensitive workers' compensation issues in collaboration with employees, internal staff, the third-party administrator (TPA), and other external partners.
4. Ensures compliance with federal and state laws and regulations and School Board policies related to workers' compensation.
5. Researches industry best practices and trends related to workers' compensation, claims management, cost containment, and return-to-work programs.
6. Works as a team member and/or leader in developing recommendations on programming, workflows, policies, procedures, and internal controls.
7. Documents, implements, and monitors changes to workers' compensation programs and business processes.
8. Prepares written and oral reports, analyses, dashboards, and presentations related to claims activity, program performance, and financial results.
9. Creates and tracks workers' compensation program and vendor performance metrics.
10. Audits claims and provides analysis of claims costs, reserves, and program expenditures; researches anomalies and identifies cost-saving and risk mitigation opportunities.
11. Provides recommendations and advice related to workers' compensation budget development, forecasting, and reserve management.
12. Participates in contracting and procurement processes, including the development and review of specifications, service requirements, and solicitation documents.
13. Collaborates with and monitors the contractual compliance, performance, and implementation efforts of the TPA and other third-party vendors.
14. Provides technical guidance and consultation to school personnel, central office staff, and leadership regarding workers' compensation processes, requirements, and responsibilities.
15. Collaborates with risk management, human resources, payroll, legal counsel, school administrators, and external partners to support claims resolution, return-to-work, and disability management activities.
16. Leads and/or participates in division-wide initiatives and special projects related to workers' compensation, risk management, and compliance.
17. Performs related duties as required or assigned.