Risk Management-Claims Administrator

Williamson County•Georgetown: 1848 Texas Trail, TX

3d•Onsite

About The Position

Reporting directly to the Director of Risk Management, responsible for administering Williamson County’s claims management program and performing the duties necessary for the successful adjudication of claims on behalf of the County. Participates in planning of programs, policies, and objectives for work group and department.

Requirements

Bachelor’s degree in a related field and two (2) years of related insurance experience; OR an equivalent combination of education and experience
Working knowledge of specific job-related technology

Nice To Haves

Bachelor’s degree in a related field
Three (3) years of claims handling experience
Risk Management certification

Responsibilities

Administers the investigation, documentation, and reporting of claims to third party administrator (TPA) and County Officials; interviews claimants, employees, doctors, medical specialists, or other witnesses for pertinent information of occurrence
Provides direct oversight activity supervising the administration of workers’ compensation claims by third party claims administrator
Requests and approves assignment of ancillary services including Nurse Case Management, Utilization Review, work hardening, vocational rehabilitation, or surveillance assignment
Directly supervises TPA and outside counsel efforts on claim administration, claim payments, subrogation efforts, and settlement negotiations
Collaborates with Risk Analyst on monthly claims reporting and claims status to departments and County Officials
Monitors TPA’s performance and compliance with their contract, ensures TPA compliance in reporting claims to insurance broker and carriers in accordance with reporting requirements, and participates in periodic audits of TPA
Participates in internal audits as required by the County Auditor
Ensures compliance with all Federal, State, and Local regulations and statutes regarding the filing of any state mandated forms, e.g., first reports of injury, supplemental report of injury, subsequent required work status reports, and wage statements
Monitors claims for statute of limitations and coordinates with in-house and outside counsel for litigation of claims, assisting with investigation and documentation; attends workers’ compensation hearings on behalf of the County to assist outside counsel as needed, providing evidence and reporting progress of hearing to appropriate County Officials
Partners with Loss Control Administrator in the management of the County’s Temporary Transitional Assignment program (TTA) for early return to work of injured workers; coordinates communication and organization with injured worker, supervisor, doctors, and TPA adjuster; provides training and communicates with the department personnel to encourage participation and coordination of efforts for success of program
Coordinates with Loss Control Administrator and Risk Analyst in identifying common claim trends, unsafe practices, and other employee risk exposures
Participates in the development and upkeep of departmental policies and procedures
Assists departments in timecard management regarding workers’ compensation leave
Reports to Human Resources any claims involving employee noncompliance with department supervisor or Risk Management directives
Works together with Human Resources on workers’ compensation claims that also involve the FMLA
Provides employee outreach and education regarding work safety
Provides departmental training on the workers’ compensation program
Creates and oversees implementation of the service instructions and claims handling procedures for the TPA
Utilizes claims management software
Creates and maintains the department’s record keeping system
Attends and participates in all meetings and trainings, as required
Serves as backup to other Risk Claims Administrators
Assists the Risk Manager on all aspects of program development under this assignment
Performs other duties as assigned
Directly handles all aspects of property damage claims, including coordination with Facilities and the involved department on damage assessments and repairs, communicates with the County’s carrier and broker, and processing of claim payments
Directly handles all aspects of auto property damage claims (non-liability), including submitting claims to other party’s carrier, processing of claim payments, and coordination with Fleet Services and the involved department on damage assessments and repairs
Administers the investigation, documentation, and reporting of claims to third party administrator (TPA) and County Officials; gathers information from claimants, employees, doctors, medical specialists, or other witnesses for pertinent information of occurrence
Provides direct oversight activity supervising the administration of auto and general liability claims by third party administrator
Requests and approves assignment of ancillary claim services as needed
Directly supervises TPA on claim administration, claim payments, subrogation efforts, and settlement negotiations
Collaborates with Risk Analyst on monthly claims reporting and claims status to departments and County Officials
Monitors TPA’s performance and compliance with their contract, ensures TPA compliance in reporting claims to insurance broker and carriers in accordance with reporting requirements, and participates in periodic audits of TPA
Gathers all information, documents/recordings, and statements regarding claim incidents for purposes of fact finding and liability determination
Coordinates with Loss Control Administrator on post-claim investigations as needed
Monitors claims for statute of limitations and assists in-house and outside counsel on additional claim investigation, claim denials, litigation, and requests from outside counsel, as needed
Submits restitution claims, including all requested documentation, to the County Attorney’s Office or District Attorney’s Office on criminal cases involving damage to county property
Coordinates with Loss Control Administrator and Risk Analyst in identifying common claim trends, unsafe practices, and other county risk exposures
Provides employee outreach and education regarding incident reporting
Provides departmental training on the property and casualty programs
Creates and oversees implementation of the service instructions and claims handling procedures for the TPA