About this role
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: • Performs activities related to the administration and management of the division-wide workers' compensation program. • Responsible for workers' compensation claims administration, including medical case management, return-to-work coordination, and disability management activities. • 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. • Ensures compliance with federal and state laws and regulations and School Board policies related to workers' compensation. • Researches industry best practices and trends related to workers' compensation, claims management, cost containment, and return-to-work programs. • Works as a team member and/or leader in developing recommendations on programming, workflows, policies, procedures, and internal controls. • Documents, implements, and monitors changes to workers' compensation programs and business processes. • Prepares written and oral reports, analyses, dashboards, and presentations related to claims activity, program performance, and financial results. • Creates and tracks workers' compensation program and vendor performance metrics. • Audits claims and provides analysis of claims costs, reserves, and program expenditures; researches anomalies and identifies cost-saving and risk mitigation opportunities. • Provides recommendations and advice related to workers' compensation budget development, forecasting, and reserve management. • Participates in contracting and procurement processes, including the development and review of specifications, service requirements, and solicitation documents. • Collaborates with and monitors the contractual compliance, performance, and implementation efforts of the TPA and other third-party vendors. • Provides technical guidance and consultation to school personnel, central office staff, and leadership regarding workers' compensation processes, requirements, and responsibilities. • 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. • Leads and/or participates in division-wide initiatives and special projects related to workers' compensation, risk management, and compliance. • Performs related duties as required or assigned.