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Position Classification Description

Position Class Code / Title: B0022 / Workers' Comp Specialist
Recruitment Tier: Tier 1
FLSA: Exempt
Grade: 11

This is a description of a Staff Position Classification. It is not an announcement of a position opening. To view descriptions of current openings, please go to UNMJobs and Search Postings to view positions that are currently accepting applications.

The following statements are intended to describe, in broad terms, the general functions and responsibility levels characteristic of positions assigned to this classification. They should not be viewed as an exhaustive list of the specific duties and prerequisites applicable to individual positions that have been so classified.

Summary

Under indirect supervision, coordinates, administers, and oversees the University's workers compensation program. Reviews, investigates, and makes decisions regarding compensability and appropriateness of claims. Processes and documents all workers compensation claims, ensuring compliance with relevant policies, procedures, and legislation. Acts as the Universitys authority on workers compensation policies and legislative provisions. Provides liaison with and advisement to external agencies and regulatory bodies in the administration of claims and in the care and disposition of claimants. Processes and handles casualty and property liability claims in the absence of the Insurance and Claims Manager.

Duties and Responsibilities

  1. Reviews and evaluates all work-related accident reports for completeness and clarity of data; analyzes data, as needed, to ensure compliance with policy and regulatory requirements.
  2. Determines appropriateness and amount of worker's compensation claims; investigates individual claims for eligibility for workers' compensation benefits; ensures that all legal and procedural requirements are met for the processing of claims, in order to ensure proper and timely payment to employees and medical facilities.
  3. Provides authoritative advice and counsel campus-wide to University officials, administrators, faculty, and staff on the interpretation and application of worker's compensation policies, legislation, regulations, and processes, as well as on loss control procedures and related regulations; designs and implements training and orientation programs to disseminate this information to the university community.
  4. Coordinates and participates in strategic planning aimed at reducing the incidence of worker's compensation-related injuries on campus.
  5. Assembles appropriate medical information and facts regarding claims for cases pending litigation; represents the university at Workers' Compensation Administration mediation and formal hearings; represents the University at trials and other mediations as requested.
  6. Communicates and interacts with medical professionals, support agencies and others to monitor and assess the progress of rehabilitation efforts, and 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.
  7. Prepares all necessary forms, records and documentation, to include statistical analyses and reports, for all claims assigned, as required by various regulatory agencies.
  8. Makes strategic recommendations for reducing the frequency and severity of losses through the use of a workers' compensation database and/or other claims data reports; designs and develops data bases, performs integrated data analyses, and prepares reports.
  9. Handles and processes casualty and property liability claims in the absence of the Mgr, Insurance and Claims.
  10. Performs miscellaneous job-related duties as assigned.

Minimum Job Requirements

  • Bachelor's degree; at least 3 years of experience directly related to the duties and responsibilities specified.
  • Completed degree(s) from an accredited institution that are above the minimum education requirement may be substituted for experience on a year for year basis.

Knowledge, Skills and Abilities Required

  • Knowledge of applicable legislation, standards, policies and procedures within specialty area.
  • Skill in conducting accident investigations.
  • Skill in examining and re-engineering operations and procedures, formulating policy, and developing and implementing new strategies and procedures.
  • Knowledge of process requirements of administrative hearings and litigation.
  • Ability to communicate technical information to non-technical personnel.
  • Knowledge of data management systems and processes.
  • Knowledge of property and liability claims legislation, regulations, policies, processes, and procedures.
  • Ability to use independent judgment and to manage and impart confidential information.
  • Ability to document work in progress.
  • Records maintenance skills.
  • Strong interpersonal and communication skills and the ability to work effectively with a wide range of constituencies in a diverse community.
  • Ability to use independent judgement and make appropriate insurance claims adjustment decisions and determinations.
  • Conflict resolution and/or mediation skills.
  • Ability to investigate and analyze claims information and to draw conclusions.
  • Ability to provide legal depositions and testimony.
  • Skill in developing and implementing return-to-work, modified duty programs.

Conditions of Employment

  • Possession of a valid New Mexico driver's license is a requirement for this job.

Working Conditions and Physical Effort

  • No or very limited physical effort required.
  • Moderate physical activity. Requires handling of average-weight objects, standing and/or walking for extended periods of times during rush and busy hours of the semester.
  • No or very limited exposure to physical risk.
  • Work is normally performed in a typical interior/office work environment.

The University of New Mexico provides all training required by OSHA to ensure employee safety.

Revised Date: 03/20/2017