CertificationsCRIS Construction Risk & Insurance Specialist
Field of studyRisk Management (or related)
Study levelAssociate degree or higher
Original posting
Under general direction, the worker's compensation specialist ensures timely processing of workers' compensation claims' evaluates accident reports to determine accuracy and completeness and to ensure adequate investigation; ensures that the state complies with applicable laws and regulations; provides training and guidance to claims coordinators in all departments; oversee and manage all Risk Management documentation and maintains an organized virtual and manual filing system.
Duties and Responsibilities
Evaluate accident reports, ensuring the timely processing of medical bills and temporary total disability benefits, review medical reports, witness statements, department investigation results, and other documentation. Compiles facts and data regarding accident reports and filed cases.
Maintains subrogation records and files for those incidents involving third parties; sends subrogation letters to third parties to obtain reimbursement of monies spent by the city for medical treatment, time loss, and awards and settlements paid; submits amounts paid for medical treatment and/or temporary total disability benefits to the State Attorney's Office to seek reimbursement in cases where criminal charges have been filed.
Reviews documentation to determine whether medical bills and temporary total disability benefits should be continued; authorizes payment of medical bills and temporary total disability benefits upon receipt of proper documentation. Advises and/or assists departments in investigating accident reports, including interviewing of witnesses and procurement of relevant documentation.
Reviews accident reports to identify patterns of injury and to determine whether unsafe conditions contributed to the accident; advises departments of trends in injuries and proper safety procedures that may result in a reduction of injuries; provides the department with information that will aid in reducing accidents and improving safety.
Trains safety coordinators in the proper procedures and forms to be utilized in workers' compensation matters and the preparation of accident reports, notices of absence, and notices of return to work following city regulations and the Workers' Compensation Act.
Documents telephone conversations, witness statements, medical reports, accident investigation results, and payment of medical bills; prepares summaries of medical reports; ensures that state claim forms are properly prepared and filed.
Attends seminars, conducts research, and maintains liaison with individuals in the medical community and healthcare fields to keep abreast of current medical procedures and medications.
Track claims from filing through follow-up with employee supervisors/claim coordinators.
Notifies safety managers of employee incidents and claims.
Manages incident case files and ensures employees' confidential access to information.
Coordinates with payroll personnel for compensation benefit plans.
Fill out pre-qualification paperwork.
Maintains the TRIR.
Monthly incidents or loss reports.
Conducts weekly Workers' Compensation meetings with the safety manager.
File injuries, auto accidents, and property damage with insurance.
Track equipment/vehicle accidents.
Set up meet & greet with physicians and clinic staff for new projects.
Maintain OSHA 300 log for Kent Companies.
Standardize, centralize, and maintain all safety forms and files for Kent Companies.
Other Duties
Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties, or responsibilities that are required of the employee for this job. Duties and Responsibilities are not comprehensive and can be changed at any time, with or without notice.
Travel
This position requires extensive travel. Travel includes traveling to all Kent Companies office locations and clinics for employees. Subject to change.
Requirements
Required Experience, Education, and Qualifications
Requires knowledge, skill, and completion of 4 years of college or associates equivalent with and three years of experience in medical claims analysis or any equivalent combination of training and experience.
A minimum of three to five (5) years of progressive safety or risk management experience with safety or risk programs and/or safety or risk training, including conducting inspections or audits or the completion of certification in Worker’s Compensation Specialist, CRIS Construction Risk & Insurance Specialist certification, bachelor’s degree in risk management (associate in physician’s assistant), and experience as a paramedic, medical assistant, medical technician, and nurse.
Computer skills- excel, dashboards, reporting.
Working knowledge of the Workers' Compensation Act, city regulations, and other applicable state/federal statutes and regulations.
Working knowledge of medical terminology, body systems, and/or impairments and their disabling effects.
Knowledge of local, state, and federal Safety Regulations, Accident & Incident Prevention, Risk Management, and insurance claims handling.
Working knowledge of office procedures and filing.
Ability to obtain facts that ensure claims information is complete and accurate.
Ability to balance casework loads and efficiently process claims.
Ability to evaluate all medical and time-loss claims information to determine the payment of temporary total disability benefits and medical bills.
Good judgment in interpreting medical facts presented by a physician and applying these facts in determining an individual's capacity to engage in gainful occupation.
Ability to read, assimilate, and recall with marked proficiency facts, figures, and descriptions and to search for and obtain information.
Effective communication skills.
Public speaking ability to express comfortably in small and large groups.
Excellent interpersonal skills and the ability to effectively relate to employees at all levels of the organization.
Strong communication skills with the ability to influence behaviors.
Effectively communicate with injured employees, safety managers, and supervisors in the field.
Efficiently document injuries via bona fide letter to ensure employee meets physician requirements to return to work.
Assist with the transition of injured employees to regular workers status.
Bilingual (English/Spanish) written and oral fluency.
Ability to maintain satisfactory working relationships with co-workers, the public, and other agency personnel.
Discretion, trustworthiness, and the ability to keep all information and materials you are privy to strictly confidential (internally and externally) are essential elements of this position.
Ability to work with minimal supervision and to independently identify work to be done.
Ability to adjust to sudden changes in work priorities.
Attention to detail and extreme care in performing tasks accurately and carefully are also essential.
Working knowledge of the tenets of supervision and motivation of employees
Valid driver’s license
Must have reliable transportation to the workplace(s)/ job location(s).
Ability to successfully pass a background check related to driving.
Ability to pass drug screening.
Must be able to work in the United States without corporate sponsorship now and within the future.
The Company expects and requires the incumbent and its other employees to observe and fulfill the above and all other safety responsibilities and actively work toward maintaining a safe workplace. Failure to do so can result in disciplinary action, including termination of employment.
Benefits
Kent Companies provides its employees with one of the most competitive compensation and benefits packages in the construction industry. Benefits vary by location, with a fully customized benefits package presented upon hire. Typical benefits packages include:
Weekly pay
PTO (Paid Time Off)
Medical, dental, and vision coverage
Supplemental insurance options
Retirement plans with discretionary employer-matching
Holiday pay (New Year’s Day, Memorial Day, Independence Day, Labor Day, Thanksgiving Day, Christmas Day)