Spec II Workers Compensation and Risk

Pay Range: $65000-$70000

JOB SUMMARY

The Workers Compensation Claims and Risk Specialist II is primarily responsible for managing the full lifecycle of workers compensation claims for the organization. This role partners directly with market managers safety teams human resources and our third-party administrator (TPA) to drive early claim resolution support injured employees and reduce total claim costs. The ideal candidate understands the physical demands and injury patterns unique to warehouse driving and delivery environments. This position supports and assists the corporate enterprise risk management program.

ESSENTIAL DUTIES AND RESPONSIBILITIES

Claim Management & Oversight

Serve as the primary point of contact for all workers compensation claims tracking and managing the full life cycle of worker injury claims to determine compensability.

Acknowledge new claims promptly; evaluate initial submissions for accuracy assess coverage and document a claim summary with identified compensability issues.

Conduct consistent proactive follow-up with TPA adjusters to actively manage open claims drive activity milestones and develop strategies for early and appropriate resolution.

Ensure adherence to state-specific workers compensation laws and assist with Occupational Safety and Health Administration (OSHA) reporting obligations.

Coordinate with occupational health providers nurse case managers modified duty outsourcing partners and internal invested parties to manage medical treatment and return-to-work programs and timelines.

Determine case reserves and negotiate settlements within approved guidelines.

Identify and escalate claims with potential for litigation fraud or excess exposure to the Director of Risk Management.

Insurance & Risk Program Support

Organize and maintain claims management files insurance policies and operational procedures on Microsoft Teams and TPA systems.

Conducts loss management system training and provides data support for various internal end users.

Assist with acquiring or gathering data and/or supporting documents for claims and leadership requests.

Assist in gathering payroll classification and loss history documentation for annual workers compensation insurance renewals and audits.

Assist with certificates of insurance (COI) program for customers and vendors.

May perform other duties in support of the risk management department.

MANAGEMENT & SUPERVISORY RESPONSIBILTIES

Typically reports to Management. Direct supervisor job title(s) typically include: Director-Risk Management

Job is not directly responsible for managing other employees (e.g. hiring/termination and/or pay decisions performance management). This position may have mentoring responsibilities i.e. (temporary help or part time employee).

JOB QUALIFICATIONS: Essential Skills Abilities and Example Behavior(s)

DELIVER QUALITY RESULTS: Able to deliver top quality service to all customers (internal and external); Able to ensure all details are covered and adhere to company policies; Able to strive to do things right the first time; Able to meet agreed-upon commitments or advises customer when deadlines are jeopardized; Able to define high standards for quality and evaluate products services and own performance against those standards

TAKE INITIATIVE: Able to exhibit tendencies to be self-starting and not wait for signals; Able to be proactive and demonstrate readiness and ability to initiate action; Able to take action beyond what is required and volunteers to take on new assignments; Able to complete assignments independently without constant supervision

BE INNOVATIVE / CREATIVE: Able to examine the status quo and consistently look for better ways of doing things; Able to recommend changes based on analyzed needs; Able to develop proper solutions and identify opportunities

BE PROFESSIONAL: Able to project a positive professional image with both internal and external business contacts; Able to create a positive first impression; Able to gain respect and trust of others through personal image and demeanor

ADVANCED COMPUTER USER: Able to use required software applications to produce correspondence reports presentations electronic communication and complex spreadsheets including formulas and macros and/or databases. Able to operate general office equipment including company telephone system

JOB QUALIFICATIONS: Education & Experience Requirements

Education:

Minimum of Bachelors degree or equivalent related experience

2 - 4 years of professional experience required

Certification licensure or professional designation in workers compensation required

Experience/Skills:

High work volume experience required

Risk or insurance experience preferred

Transportation risk experience a plus

Knowledge of claims handling techniques a plus

Proficient with MS suite of products and computer technology

Analytical skills with follow-up and sense of urgency

Organizational time management and prioritization skills

Interpersonal written and oral communication skills