Claims Analyst - Risk Management
Gwinnett County Public Schools
Office Professionals/Claims Analyst
|Job Code: Claims Analyst - 030182||Standard Hours: 40||Department: Risk Management - 252521||Empl Class: NA|
|Minimum Salary: $27,073.00/Annually|| Maximum Salary: $47,576.00/Annually|| Scheduled Days: 246|| Target Openings: 1|
Workers' Compensation Professional certificate preferred.
High school diploma or equivalent required. Bachelor's degree in related field preferred.
Ability to communicate effectively, including oral and written presentations; ability to read and comprehend simple instructions, short correspondence, and memos; ability to write simple correspondence; ability to read, comprehend, and apply complex statutory Workers' Compensation regulations; ability to exercise independent judgment, troubleshoot, and solve problems; ability to read, comprehend, and apply complex insurance policy language; ability to work independently; ability to use common sense; ability to deal with problems involving concrete variables; excellent computer application skills; basic mathematics skills; flexibility and adaptability to change; and ability to represent Gwinnett County Public Schools in a positive and professional manner.
Five years in Property and Casualty insurance and Workers' Compensation required.
Perform a variety of professional duties in support of the Gwinnett County Public Schools (GCPS) Risk Management Department including reviewing, examining, investigating, and analyzing Workers’ Compensation, fleet, property, and general liability claims and handling claims that vary in complexity from inception to end. This position also provides information and assistance to the district's personnel, injured employees, claims administrators, vendors, and medical and legal professionals.
ESSENTIAL JOB DUTIES
1. Review, examine, investigate, and analyze Workers' Compensation claims.
a. Interact with injured employees to ensure awareness and understanding of the Workers' Compensation process, requirements, and entitlements.
b. Organize medical treatment for injured employees and provide information to treating physicians regarding employees’ medical history, health issues, and job requirements.
c. Serve as a liaison between medical providers, employees, legal professionals, vendors, and school district.
d. Inform departments of injured employees' work restrictions and coordinate appropriate accommodations and benefit payments.
e. Review and interpret doctors' reports to ensure that the appropriate American Medical Association (AMA) guidelines have been applied when reporting disability, impairment, and appropriation.
f. Identify subrogation potential and pursue the process of reimbursement.
g. Communicate with defense attorneys regarding litigated cases, make recommendations regarding proposed settlements, and attend hearings and mediations when needed.
h. Interpret and apply pertinent federal, state, and local codes, law, regulations and AMA guidelines.
i. Maintain a record of Panel Physician performance issues and make recommendations regarding the makeup of the panel.
2. Review, examine, investigate, and analyze fleet, property, and general liability claims.
a. Determine insurance coverage by examining claims forms, policies, and other records.
b. Interview claimant and witnesses, consult with police and hospital/doctors records, and inspect property damage.
c. Serve as a liaison between employees, legal professionals, vendors, and school district and coordinate with applicable departments in gathering needed information to process payments and reimbursements.
d. Settle claims by determining insurance liability and reach agreement with claimant within policy provisions.
e. Identify subrogation potential and pursue the process of reimbursement.
f. Establish claim reserves by estimating the cost of the assigned claim and monitor reserves and update amounts as necessary.
g. Communicate with defense attorney regarding litigation cases and make recommendations regarding proposed settlements.
h. Prepare, process, and submit claims to the excess insurance carrier for consideration.
3. Perform other duties as assigned.
While performing the duties of this job, the employee is frequently required to sit for extended periods of time. The employee is also required to talk, hear, stand, and walk. The employee may be required to use hands to finger, handle, feel, and/or reach. The employee is occasionally required to stoop, kneel, or crouch. The employee must occasionally lift and/or move up to 25 pounds. Specific vision abilities required by this job include close vision, distance vision, color vision, depth perception, and ability to adjust focus. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
HELPING STUDENTS ACHIEVE
Gwinnett County Public Schools provides a quality and effective education for all students by focusing on its core business of teaching and learning. Since its inception in 1996, GCPS’ AKS curriculum has reflected the collective wisdom of thousands of educators and community members who worked together to determine what students need to know and be able to do in order to be successful at the next grade level and in the future.