Workers Compensation Coordinator

PURPOSE

To improve student achievement by fulfilling duties related to safety, loss control, and claim management of the District’s self-insured workers compensation program.

SUPERVISION RECEIVED AND EXERCISED

Receives direction from an assigned administrator. Methods of performing tasks are the responsibility of the employee and are to be performed within the established policies or as prescribed by rules and regulations. Work is reviewed periodically to assure compliance to standards and measured results.

ESSENTIAL FUNCTIONS OF THE JOB

May include, but are not limited to, the following

NOTE: Actual job duties may vary based on department and/or function.

1. Preparing a variety of analytical reports on operations and activities in assigned area of responsibility.
2. Serving as a technical resource for district information in assigned area of responsibility.
3. Developing and providing training to District staff.
4. Ensuring District compliance with state and federal rules, regulations and laws. Regularly review and stay abreast of applicable laws that may impact how claims are processed.
5. Ensure appropriate claim reserves are established with the district's Third Party Administrator (TPA) by estimating the cost of each claim and regularly monitoring reserves.
6. Identify subrogation potential and work with the district's TPA to pursue reimbursement.
7. Serve as a liaison between medical providers, employees, legal professionals, and district schools and departments. Interact with injured employees to ensure awareness and understanding of the workers’compensation process, requirements, and entitlements. Communicate return to work expectations and claim status with supervisors.
8. Review and interpret medical reports to ensure that causation is addressed, the mechanism of injury matches the diagnosis, work capabilities / restrictions are documented, and an appropriate treatment plan is in place. Communicate with physicians, Managed Care Organization (MCO) representatives, and TPA contacts when concerns are identified.
9. Coordinating and promoting light duty opportunities for injured workers within the scope of union contracts, District policies, and workers' compensation statutes. Ensuring maximum reimbursement for Employer-At Injury Program.
10. Process light duty time-tracking for injured employees and provide documentation to the TPA in order for accurate and timely disability benefits to be issued.
11. Establishing and managing proactive action plans on open workers compensation claims to support timely resolutions. Providing medical, disability, and litigation management on workers compensation claims to achieve positive claim outcomes in a cost-effective manner.
12. Completing AOE/COE (Arising Out of Employment / Course of Employment) investigations to include gathering information from District leadership, human resources, witnesses, staff members, social media, and /or directing further investigation efforts from the District's Third Party Administrator (TPA) to address industrial causation.
13. Identifying and recommending potential settlement opportunities for the District. Completing settlement evaluations to identify the claim exposure and recommending settlement values.
14. Communicate with defense attorneys regarding litigated cases; make recommendations regarding proposed strategies for claim resolution.
15. Coordinating with human resources and the district's TPA in proper administration of the workers’ compensation re-employment and re-instatement regulations for qualifying injured workers and oversight of the vocational rehabilitation process, when indicated.
16. Providing technical assistance to employees, supervisors, unions, and others as necessary.
17. Identify opportunities in our claims management process to mitigate risk and streamline the claims process.
18. Supporting compliance with Occupational Safety and Health Administration (OSHA)'s record-keeping requirements related to OSHA 300 log, 300A summaries, and 301 forms.
19. Develop and maintain internal systems for data collection and entry, financial analysis, and report generation; create and update spreadsheets, logs, and diary as necessary.
20. Developing and providing periodic reporting on claims activity and effectiveness of the TPA.
21. Attend and participate in staff meetings to provide training and keep supervisors informed of status on all assigned cases and plan of action. Stay abreast of new trends, pending legislation, and case law related to workers’ compensation.
22. Provide departmental support through involvement with the incident command center, emergency response, and may participate in an after-hours on-call rotation.
23. Performing related duties consistent with job description and assignment.

MINIMUM QUALIFICATIONS

Knowledge of

1. Relevant federal, state and local laws and regulations governing workers’ compensation
2. Legal, medical, and technical terminology used in industrial injury cases.
3. Basic principles and practices of analytical, statistical and financial report preparation.
4. Principles and practices of record keeping and records management.
5. Principles and procedures of financial record-keeping and reporting.
6. Principles and practices of safety, loss control, and claims administration.
7. Work organization and research techniques sufficient to collect, analyze and interpret data.
8. Basic office practices, including organization, data entry, record keeping, computer equipment, and computer software applications, including claims processing techniques.

Ability to

1. Interpret, apply, and explain policies, practices, laws, statutes, regulations,and procedures.
2. Independently plan and effectively fulfill responsibilities of assigned area of work.
3. Conduct research, compile, and analyze information.
4. Prepare complex technical reports and correspondence.
5. Create and maintain a variety of ledgers, logs, records, and reports.
6. Work independently with little supervision.
7. Work effectively in a team environment.
8. Maintain highest level of confidentiality in all matters.
9. Type at a speed necessary for successful job performance.
10. Exercise diplomacy and tact when dealing with others.
11. Communicate clearly and concisely, both orally and in writing.
12. Establish and maintain cooperative-working relationships with other employees and the public.
13. Provide excellent customer service.
14. Adapt to changing technologies and learn functionality of new equipment and systems.

EXPERIENCE AND TRAINING

Any combination of experience and training that would provide the required knowledge and abilities is appropriate. A representative way to obtain the required knowledge and abilities would be:

Experience

1. 2+ years of workers compensation claims experience
2. Experience handling litigated and lost-time files
3. Previous experience working directly for an insurance carrier or TPA

Training

Successful completion of the workers’ compensation claims examiner certification program recognized by the Workers’ Compensation Division of Oregon. (Or the willingness to earn this certification within 1 year of hire).

Equivalent to a Bachelor’s degree from an accredited college or university. (Relevant work experience may be substituted for the education requirement)

Work Environment

Climate controlled office setting with possible exposure to low to high noise intensity levels.

High level of contact with district personnel, and moderate contact with outside agencies/ community.

Physical Requirements

Frequent reaching, handling, fingering, talking and hearing. Mobility to work in a typical office setting and use standard office equipment, stamina to remain seated and maintain concentration for an extended period. Hearing and speech to communicate in person or over the telephone. Vision to read printed materials, computer screens and/ or other monitoring devices.

Strength: Sedentary/Medium – Exert force to 15 pounds occasionally or a negligible amount of force frequently to lift, carry, push, pull or move objects.