Risk Management Claims Specialist
- Title: Risk Management Claims Specialist
- Class: Classified
- Exempt Status: Non-exempt
- Grade: 19
Under the general supervision of the Safety and Risk Manager, positions assigned to this classification are responsible for obtaining, recording and maintaining related College risk management activities. Typical responsibilities include administering the Return-To-Work Program, investigating and filing workers compensation and liability claims, working with safety committees and the associated documentation and responding to employee requests for ergonomic accommodations.
Typical Duties and Responsibilities
- Receives and processes notices of claims and documents, and other reports related to claims for the College. May obtain claim information from a variety of sources including in-person complaints, over the phone, or email.
- Conducts investigations and gathers information regarding claims made against the College, when necessary. As requested, gathers additional information for attorneys or insurance agencies related to on-going investigations.
- Completes all liability and workers compensation claim forms, gathers supporting documentation collected during investigations, and forwards to appropriate stakeholders.
- Works in coordination with the Risk Manager and General Counsel and TPA on complex claims for fiscal responsibility and to minimize associated costs. Makes fiscal decisions at the appropriate authorized level.
- Files claims and necessary forms and documents obtained during investigations with appropriate insurance carriers or agencies. Tracks proof of loss statements and status of claims as necessary.
- Creates and maintains claim files and trending assessments for workers compensation, liability and property claims. Tracks relevant information with applicable database, and closes files as needed.
- Receives, maintains and reports damage of College property to appropriate departments. Handles all third party claims and tracks payment status.
- Reviews requests for ergonomic accommodations according to policies and procedures working with insurance companies and employees. Recommends actions and other details as needed.
- Administers the PCC Return-To-Work-Program. Works with Human Resources to develop modified jobs and schedules to facilitate employee early return-to-work.
- Acts as Risk Manager’s representative to the PCC district Drivers Review Board.
- May perform all or some of the responsibilities above and other related duties as assigned.
Work Environment and Physical Requirements
Work is typically performed in a normal office environment and requires use of personal vehicle for travel throughout the district. Learned physical skill is required to perform keyboarding and/or ten key functions. Occasional lifting, guiding and/or the carrying of materials may be required.
Associate’s degree in Business Administration or related area. Experience performing the duties described above may substitute for the degree requirement on a year-for-year basis. Two years’ relevant experience in Claims Management activities including, but not limited to, claims administration, safety training and loss control.
Knowledge, Skills, and Abilities
- Policies and procedures used to understand and process workers compensation and liability and property claims;
- Safety committee regulations and policies;
- State and federal law for OSHA.
- Critical thinking;
- Good time management;
- Customer service skills working with a diverse population. This includes various groups of people such as the public, college staff, governmental agencies, insurance companies and adjustors presenting and exchanging information that may be technical or complex;
- Skilled at explaining terms, concepts and technology in plain language.
- Draw from knowledge and past experience in resolving issues not clearly defined in established policies and procedures;
- Effectively communicate, both in writing and verbally;
- Be collaborative and an active listener;
- Remain calm in difficult situations;
- Resolve complaints/issues;
- Analyze and resolve problems with minimal supervision;
- Build relationships on campuses and district-wide;
- Work with multiple priorities in a fast-paced and changing environment.
- Revised 01/2014