Risk Specialist - GP3217-860002
City of Denton
Job Description
Title: Risk Specialist
Position ID: GP3217-860002
Department/Division: Human Resources/Risk Management
Reports to: Risk Manager
FLSA Designation: Exempt
Safety Sensitive: No
DOT: No
Definition: Responsible for administering the City's self-funded workers' compensation and return to work programs, including day-to-day oversight of the workers' compensation third-party
administrator. Administers the post-employment drug and alcohol testing and CDL Clearinghouse programs. Assists the Risk Management division with various duties, including acting as
the back-up for the Claims Administrator; maintains complete and accurate information in the RMIS; provides outstanding customer service to all internal and external customers.
Essential Functions:
Administration of the City's self-insured workers' compensation program, including authorizing medical claims expenses, within authority level.
Development and administration of a return to work program to assist injured workers to return to the workplace, including coordination with departments on the development and placement
in light-duty positions.
Administration and oversight of the workers' compensation third-party administration (TPA). Verifies the integrity of the file transfer between the Risk Management Information System
(RMIS) and vendor's claims management systems. Completes daily and monthly bill reconciliation and regular audit of workers' compensation billing and other Risk expenditures to ensure
accurate billing and payment. Approves daily and monthly claims billing within authority level.
Responds to requests for information and may act as a liaison between claimants, healthcare providers, attorneys, residents, employees, management, and other customers with required
information on all types of claims. Provides data when requested for actuarial review studies and audits.
Enters and maintains current and accurate information in the RMIS. Set-up of initial claim files in RMIS.
Works closely with the Benefits and Leave Coordinator to ensure employees' workers' compensation leave is coded accurately in the payroll system (KRONOS).
Ensures compliance with the applicable provisions of federal, state, and local laws, regulations, ordinances, and other standards (e.g., Medicare, HIPAA, data privacy). Preserves confidentiality
of Protected Health Information (PHI), Personally Identifiable Information (PII), and applicable documentation and files, when applicable.
Administration of the random and post-accident drug and alcohol testing program and the Department of Transportation's Commercial Driver's License (CDL) Clearinghouse program.
Provides education and guidance on complex claims processes (e.g., workers' compensation, auto, property, and casualty) to internal and external customers. Creates and provides training
to departments on workers' compensation and other Risk Management topics.
Tracks data and information and composes reports as requested by management and team members.
Remains educated in the state and local laws governing Texas public sector workers' compensation, bodily injury, auto, property damage, other general liability, and excavation activities.
Processes check requests, wires, ACH, and other payment methods to ensure timely payment of all Risk related administration fees, premiums, claims, etc.
Serves as back-up to the Claims Administrator for Railroad Commission (RRC) disputes, underground utility damage, and first-party property claims.
Serves as the back-up to the Claims Administrator and other Risk Management team members as needed, including but not limited to general liability and subrogation claims. May assist
with claims handling for general liability and subrogation claims, as needed.
Assists Risk team with investigations, conducts interviews, field documentation of accident scenes, and worksites, as needed. Receives and investigates inquiries that are submitted through
the Engage Denton app.
Assists with the gathering and submission of responsive documents for Public Information Act (PIA) open records requests.
Answers the main Risk Management division telephone line and provides Outstanding Customer Service to all internal and external customers. Adheres to customer service expectations of
the department including Same Day Response to customers.
Assists with the preparation of bids/RFPs for various Risk programs and provides contract management. Prepares and tracks departmental purchase orders; assists with other purchasing
processes.
Assists with special projects and events (e.g., Flu Shot Clinic, Employee Appreciation Day, Annual Service Awards Banquet, Benefits and Wellness Fair) as needed; may serve on committees.
May be assigned the responsibility of conducting special research assignments; assists other Human Resource and Risk Management team members with various tasks and issues.
Performs a variety of delegated research, tasks, and projects; prepares reports or other illustrative materials as required; documents and presents findings upon completion.
Demonstrates regular attendance and punctuality at work and to meetings, adherence to policies and standards, trustworthiness, reliability, dependability, personal organization, attention
to detail, focus, flexibility, and overall effectiveness in simultaneous work assignments.
Engages in highly interactive face-to-face relationships with any level of employee that will require being physically present at work regularly; exhibits a temperament that strengthens
trust and respect with each customer and team member.
Oversees special projects as assigned, including assisting other HR and Risk Management team members, as needed.
Shows respect for the nature of a wide variety of City jobs and individuals within those jobs in a public environment.
Must adapt to changing priorities and show a willingness to perform other duties as assigned.
Maintains regular and punctual on-site attendance.
Additional Duties:
Performs other duties as assigned.
Must be able to work on-site Monday through Friday, 8:00 am to 5:00 pm.
Laserfiche clean up and retention of documents.
This position requires outside fieldwork, including on-site inspections and investigations.
Minimum Qualifications / Acceptable Equivalency:
Bachelor’s degree in a related field;
AND
A total of four (4) years of claims adjusting experience, with at least 2 of those years adjusting Texas workers’ compensation claims;
OR
Four (4) years of experience managing an internal workers’ compensation program, including return to work, for an organization.
Experience administering or adjusting workers’ compensation claims for a Texas public entity, preferred.
OR
Any combination of related education, experience, certifications, and licensure that will result in a candidate successfully performing the essential functions of the job.
Core Competencies:
Ability to build successful, collaborative, and genial relationships and to gain the confidence and trust of others through honesty, integrity, and authenticity.
Builds strong internal and external customer relationships and delivers customer-centric solutions.
Ability to maneuver comfortably through and explain complex policy, process, and people-related organizational dynamics.
Ability to use initiative to take empowered action to solve routine problems within policy guidelines and seeks creative solutions for non-routine challenges; effectively handle several
problems or tasks and remain calm in stressful situations.
Takes on new opportunities and tough challenges with a sense of urgency, high energy, and enthusiasm.
Handles conflict situations effectively, with minimum disruption.
Skilled at developing and delivering multi-mode communications that convey a clear understanding of the unique needs of different audiences.
Relates openly and comfortably with diverse groups of people.
Skilled in the use of a personal computer to include Microsoft Office programs and other software programs.
Ability to communicate effectively in both written and oral communication; expresses oneself clearly in business writing; uses appropriate grammar and vocabulary that does not detract
from credibility; organizes ideas clearly and speaks logically so others can follow the reasoning.
Ability to think beyond the immediate issue to look at the root cause of the issue; uses good judgment in sharing information and maintaining confidentiality.
Ability to resolve problems in a systematic, step-by-step way; thinks about the chain of events that led to a problem; waits for all the information before evaluating options; thinks
through a problem before offering a solution; uses past experiences to quickly evaluate situations where information may be incomplete or unclear.
Ability to follow through on assignments; accept work assignments from multiple managers and work areas; handle multiple and parallel projects.
Become and remain educated in the federal, state, and local laws and regulations governing Department of Transportation requirements regarding CDL and alcohol and drug testing, workers'
compensation, general liability, auto, property damage, and excavation activities.
Preferences:
Bilingual in Spanish and English
Conditions of Employment:
Must have and maintain a valid Texas Class “C” driver’s license and valid state required minimum automobile liability insurance prior to employment (must obtain Texas Class “C” driver’s
license and state-required minimum automobile liability insurance within 90 days of hire per state law)
Must pass a drug test, driver’s license check, and criminal history background check.
Must be able to work outside of business hours, as required.
Must be able to work on-site during core business hours of Monday through Friday, 8:00 am to 5:00 pm.
Physical Requirements:
Overall Strength Demands: The bold and italicized word describes the overall strength demand of the functions performed by the incumbent during a typical workday.
Sedentary – lifting no more than 10 pounds
Light – lifting no more than 20 pounds; carry up to 10 pounds
Medium – lifting no more than 50 pounds, carry up to 25 pounds
Heavy – lifting no more than 100 pounds, carry up to 50 pounds
Very Heavy – lifting more than 100 pounds, carry more than 50 pounds
Physical Demand Codes: The following describes if the incumbent is expected to exert the following physical demands during a typical workday and the overall frequency.
Codes for “how often”:
Y = Yes
N = No
E = extensive (100-70%)
M = moderate (60-30%)
I = infrequent (20-10%)
A = almost never (<10%)
Task: Code:
Standing: I
Sitting: E
Walking: M
Lifting: I
Carrying: I
Pushing/Pulling: I
O
verhead Work: A
Fine Dexterity: E
Kneeling: I
Crouching: I
Crawling: A
Bending: M
Twisting: I
Climbing: A
Balancing: A
Vision: E
Hearing: E
Talking: E
Video Display: E
Differentiate Color: Y
Machines, Tools, Equipment, and Work Aids:
The essential functions of this position require the daily use of basic office equipment such as calculators, fax machines (hardware and online), printers, computers (laptops and desktop),
digital copy machines, mobile phones, scanner machines, digital cameras, and other machinery related to work. May need a hard hat, safety vest, and/or boots for some field claim investigations.
Environmental Factors:
The essential functions of this position are performed in an office environment. However, some level of field claims investigation will be necessary under various environmental conditions.
This job description is not an employment agreement, contract agreement, or contract. Management has the exclusive right to alter this job description at any time without notice.
ADA/EOE/ADEA
Effective Date: 10/21/2020
Revision Date: 7/9/2021