Worker's Compensation Specialist

Marketing Statement

The Workers' Compensation Specialist assists in the administration, tracking, and oversight of work-related injury and illness claims programs. Acting as a bridge between employees and external partners, this role supports claims management activities, workers' compensation program compliance, and return-to-duty efforts. This position serves as a resource for employees with questions regarding workers' compensation claims and programs and assists with claim-related documentation and processes. It also serves as a liaison between WMATA, the Third-Party Administrator (TPA), and legal counsel, while supporting oversight of claims activities and facilitating the timely exchange of information. The Specialist works closely with department managers, Workforce Availability (Light Duty), and other stakeholders to support employee participation in WMATA's Light Duty program. The role also collaborates with OHAW, Payroll, Human Resources, and other internal departments to coordinate claim-related activities and support the effective administration of WMATA's workers' compensation programs.

The Workers’ Compensation Specialist is responsible for assisting in the management and administration of WMATA’s Workers’ Compensation claims programs.

Principal Job Duties

• Manages Worker’s Compensation (WC) “Return to Duty” process, coordinating with operations, payroll, Third Party Administration (TPA), and other departments.
• Assists Manager, Workers’ Compensation in oversite of the WC TPA to ensure compliance with Workers’ Compensation Claims Manual (WCCM) and WC Policy Instruction (P/I).
• Develops and conducts regular training as directed by Manager, Workers Compensation with respects to WCCM, (including but not limited to WC claim reporting procedures, WC P/I, new WC rules/laws and WC fraud recognition and prevention) to ensure and improve effectiveness and efficiency of WC claims programs.
• Liaison for litigated WC claim activity between WMATA litigators (Counsel) and WMATA TPA to improve coordination of claim activities through ongoing communications and timely exchange of information.
• Provides a channel into WMATA internal departments (including but not limited to OHAW, Operations, HR, Payroll) to assist TPA claim adjusters in accessing internal information that is necessary to adjust claims.
• Assists with internal processing of invoices, recovery of checks/drafts, procurement activities, obtaining wage information, PARP requests, and other activities associated with the management of WMATA WC programs as directed by Manager, Workers Compensation.
• Analyzes WC claims for unsafe conditions and/or means to improve safety in WMATA work environment.
• Assists with the management of data in WMATA’s Risk Management Information Systems RMIS system (Origami) and TPA claims system(s) to ensure accuracy of data and assist in the management/coordination of data between the two systems, WMATA RMIS and TPA claims systems.
• Represents WMATA as an expert witness in litigated claims.
• Assists Manager, Workers’ Compensation in conducting audit of WC TPA to ensure compliance with WCCM, WC P/I and TPA contract.
• Analyzes WC claims for unsafe conditions and/or means to improve safety in WMATA work environment.
• Works with WMATA Workforce Availability (Light Duty) to maximize participation of eligible employees in WMATA’s Light Duty program.
• Acts as resource for answering questions about Workers’ Compensation and WMATA’s WC claim programs

Other Duties

• N/A
• Maintains and promotes awareness and accountability with safety policies and procedures while performing job functions. Promotes a positive safety culture and encourages reporting of safety concerns consistent with our Agency Safety Plan, other regulatory requirements within the Safety Management System and just culture principles.

The functions listed are not intended to limit specific duties and responsibilities of any particular position. Nor is it intended to limit in any way the right of managers and supervisors to assign, direct and control the work of employees under their supervision.

Knowledge

• Advanced knowledge of how WC claims are adjudicated particularly with respects to use of a TPA
• In depth knowledge of WC laws and litigation procedures for DC, MD, and VA
• Advanced knowledge of WC coverage including but not limited to what is a compensable claim and which jurisdiction a claim is compensable in

Skills

• Skilled at communicating effectively complex WC concepts with diverse persons who have no or little knowledge of WC
• Skilled in the use of computers, printers, scanners including Microsoft products and use of Risk Management Information Systems (RMIS) and other computer systems
• Skilled in detailed analysis of claim data, costs information, and details as to the particulars of claim circumstances

Abilities

• Empathetic, positive, and professional interactions with injured employees, Claim Adjusters from TPA, attorneys, and WMATA persons from operational effectiveness
• Ability to work with and protect confidential information

Machine, Tools, Equipment, Software, Hardware Required

• Personal Computers, printers, scanners including Microsoft products and general office equipment

Supervisory Responsibility

Minimum Education

• Bachelor’s degree in Business, Business Administration, Law, Finance, Health Services or related field
  • In lieu of a Bachelor’s degree, degree, an Associate’s Degree and two years of experience performing workers’ compensation claims adjusting, liability claims adjusting or litigation paralegal work, in addition to the experience stated below, will be considered

Minimum Experience

• A minimum of three (3) years’ experience specific to workers’ compensation claims adjusting, insurance brokering, or single or multi line claims adjuster

Minimum Certification/Licensure

• N/A

Preferred Qualifications

• WC Claims Adjusting and/or Broker
• Workers’ Compensation Paralegal