Worker’s Compensation Specialist - Human Resources

JOB DESCRIPTION

Title

Employee Services Workers Compensation Specialist

Department

Human Resources

Reports To

Employee Services Coordinator

Compensation

AP 501

Days

226

Revised: 06/09/2025

PRIMARY PURPOSE:

Responsible for oversight of third-party administration (TPA) of benefits and management of the districts workers compensation program in accordance with departmental District Texas Department of Insurance and Division of Workers Compensation (DWC) procedures rules regulations and laws.

MINIMUM QUALIFICATIONS

Education and Certification Requirements

• Bachelors degree from an accredited university or equivalent years of work experience in workers compensation or related field
• Valid Texas Drivers License a good driving record and proof of insurance on vehicles used to travel to district
• Available transportation during entire workday to travel to sites in the greater San Antonio area
• Candidate must have satisfactory outcome of fingerprinting background check. Non-refundable fee (approximately $50.00) paid by the employee.

Special Knowledge and Skills

• Ability to meet established deadlines
• Strong organizational skills with attention to detail and accuracy
• Knowledge of administration of employee benefits programs
• Ability to interpret and disseminate insurance and benefits information to individuals and groups
• Working knowledge of medical and legal terminology practices and procedures
• Skill in Windows-based database word processing spreadsheet and presentation software applications (MS Office)
• Ability to handle multiple tasks plan and schedule priorities accordingly
• Proficiency in typing keyboarding and file maintenance
• Ability to use personal computers and software to develop spreadsheets databases and do word processing
• Knowledge of basic accounting principles
• Knowledge of public-school policies and procedures
• Exceptional oral and written customer service oriented interpersonal relations and business skills
• Bilingual - English & Spanish (Preferred)

Experience:

• Minimum of three (3) years of experience in benefits administration insurance administration or other related fields

MAJOR RESPONSIBILITIES AND DUTIES:

(The following statements describe the general purpose and responsibilities assigned and should not be construed as an exhaustive list of all responsibilities skills efforts or working conditions that may be assigned or skills that may be required.)

• Respects the confidentiality of the position.
• Assumes clerical function as assigned.
• Assists with communication and meeting deadlines for Payroll.
• Serves as the Districts Primary Point of Contact for Workers Compensation.
• Processes the first reports of injury reviews all claim information and workers compensation records to forward to Third Party Administrator (TPA) to facilitate the claims process in the time frame mandated by the Texas Department of Insurance Division of Workers Compensation (DWC).
• Collaborate with Third Party Administrator (TPA) to coordinate treatment scheduling with treating doctors and referral doctors.
• Completes and files DWC reports per DWC guidelines.
• Interviews with injured employee (claimant) to provide a record of alleged injury.
• Identifies and interviews and witnesses to the injury.
• Requests claimants records regarding prior medical treatment accidents and injuries to review for pre-existing injuries.
• Contact claimants to explain workers compensation benefits leave of absence leave offset policy and assist with coordination of other benefits.
• Assists claimants with information regarding the necessary paperwork (leave offset DWC forms) and coordinates a claimants absence from work and/or return to work with supervisor/principal and HR department as needed.
• Provides the Payroll department with the necessary information to answer payroll inquiries related to injured employees.
• Monitors claims and identifies third parties responsible for the injury to coordinate subrogation efforts with TPA.
• Collaborates with TPA to manage claims to ensure the maximum medical improvement is reached.
• Collaborates with TPA regarding pertinent information needed for peer reviews independent medical examinations and impairment evaluations as needed to effectively address any claim issues.
• Coordinates with TPA as needed to supply information needed for private investigation services as appropriate.
• Discuss cases with claims adjusters and legal representatives to determine necessary services to support any disputes.
• Attend quarterly TPA reviews with the Coordinator/Director to discuss open claims and possible resolutions.
• Works with Leave Specialist on claimants leave information and work status to follow FML/TDL guidelines running concurrently with WC.
• Provides updates to the Coordinator/Director on dispute resolution and on safety violations.
• Conducts training and education sessions for large and small staff groups on Work Compensation/occupational injury policies and procedures
• Reconciles Medicare billing issues with TPAs.
• Assists with new employee orientations open enrollment new teacher academy and health fair.
• Answers employees questions concerning insurance and/or leave and provides answers to carriers regarding employee status and benefits.
• Assist in reviewing the Board Policy for leave compliance.
• Provides high level compliance direction for leave administration.
• Acts as a liaison with campuses/departments Human Resources and Payroll office regarding leave sending appropriate leave documentation and official leave notifications to include change in benefit status and leave ending notice as appropriate.
• Bills employees for benefit premiums not collected due to leave status.
• Perform other duties as assigned based on department needs.
• Must complete designated district technology proficiency each year.
• Requires a basic knowledge of technology/computer skills.
• Ability to use personal computers to access district programs emails and other resources.
• Follow district safety protocols and emergency procedures.
• Maintain a consistent professional demeanor and appearance
• Ensure compliance with the Texas Educators Code of Ethics
• Daily attendance and punctuality at work are essential functions of the job

Supervisory Responsibilities:

N/A

Equipment Used:

• Office equipment personal computer printer calculator multi-line telephone software programs and peripherals copier fax and other equipment applicable to position.

Mental Demands:

• Ability to read concentrate communicate effectively (verbally and written) interpret reason understand verbal instructions memorize coordinate compile compute analyze differentiate
• Work with frequent interruptions and maintain emotional control under stress

Physical Demands:

• Frequent: Sitting standing walking climbing stairs and/or ramps balancing stooping kneeling crouching crawling pulling pushing reaching repetitive hand motions hearing speaking clearly visual acuity distinguishing colors driving traveling
• Occasional: Lifting moderate 15-44 pounds

Environmental Factors:

• Frequent exposure to temperature extremes (hot and cold) humidity extremes noise low or intense illumination vibration
• Occasional exposure to biological hazards (communicable diseases bacteria insects mold fungi etc.)
• Work alone work prolonged or irregular hours

Required Experience:

Unclear Seniority