Job Title: Claims Specialist

Reports to:Manager, Claims Administration
Typical Schedule:245 days/7.5 hours
Bargaining Unit:USEP INS

 

FLSA:Exempt
Job Code:5138
Salary Schedule:79N

JOB GOAL

Responsible for performing advanced, specialized, complex duties related to claims administration. This includes analyzing work processes and personnel/staffing functions to ensure accuracy, efficiency and timeliness; particularly relating to the administration of workers’ compensation, student athletic insurance and liability claims.

ESSENTIAL DUTIES & RESPONSIBILITIES

The following statements are intended to describe the general nature and level of work being performed by individuals assigned to this position. These statements are not intended to be construed as an exhaustive list of all duties and responsibilities required of those in this position.
  1. Develop and prepare claims administration communications and educational materials for employees.
  2. Provide training related to claims administration processes, ensuring that district and school-based employees responsible for claims data entry understand and adhere to established processes.
  3. Plan, organize, and coordinate activities related to workers’ compensation, liability, and student athletic insurance programs.
  4. Maintain data integrity in systems by running queries to perform audits and analyze data.
  5. Resolve discrepancies and exceptions on all matters pertaining to claims administration.
  6. Develop and prepare a variety of reports or queries for ongoing administrative needs; and prepare periodic reports for the Division of Workers’ Compensation and other federal and state agencies.
  7. Serve as a liaison to coordinate workflow and procedures between claims administration and other departments, including payroll, finance, information systems, school-based personnel and third-party administrators.
  8. Provide excellent customer service to all stakeholders.
  9. Develop and maintain updated procedure manuals; and make recommendations for process improvements as appropriate.
  10. Update and maintain records within claims administration system.
  11. Assist with preparation of confidential reports for claims administration.
  12. Perform other duties as assigned.

MINIMUM REQUIREMENTS

Requirements are representative of minimum levels of knowledge, skills and/or abilities. To perform this job successfully, the incumbent will possess the abilities or aptitudes to perform each duty successfully. Reasonable accommodations may be made to enable qualified individuals with disabilities to perform the essential functions.

KNOWLEDGE, SKILLS & ABILITIES

  • Operating knowledge of computer programs, including email, word processing, spreadsheets, and databases
  • Ability to maintain accuracy of data in systems
  • Ability to communicate effectively with a variety of audiences, orally and in writing, including electronic media
  • Ability to organize, prioritize, manage and carry out duties efficiently and within established timeframes
  • Ability to establish and maintain collaborative working relationships with all stakeholders

EDUCATION, TRAINING & EXPERIENCE

  • Associate degree or equivalent (2 years of college coursework)
  • Three years of related work experience
  • OR
  • Any equivalent combination of education and experience which provides the required knowledge, skills, and abilities to perform the essential duties and responsibilities of the position

CERTIFICATES, LICENSES & REGISTRATIONS

None

PREFERRED QUALIFICATIONS

  • Bachelor’s degree from an accredited institution

SUPERVISORY RESPONSIBILITY

None

PHYSICAL REQUIREMENTS

Sedentary: Exerting up to 10 pounds of force occasionally and/or a negligible amount of force frequently to lift, carry, push, pull or move objects. Sedentary work involves sitting most of the time. Jobs are sedentary if walking and standing are required only occasionally and all other sedentary criteria are met.

PHYSICAL ACTIVITY

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.

While performing the duties of this job, the employee is required to sit, talk and hear; stand and walk; use hands to finger, handle, or feel; reach with hands and arms. The employee occasionally lifts and/or moves up to 25 pounds. Specific vision ability required by this job includes close vision, distance vision, and the ability to adjust focus.

WORKING CONDITIONS

Indoors and Outdoors: The worker is subject to both environmental conditions. Activities occur inside and outside.

MACHINES, TOOLS, EQUIPMENT

  • General office equipment, including personal computers, fax machines, copiers, telephones, etc.

TERMS OF EMPLOYMENT

Salary and benefits shall be paid consistent with the District’s approved compensation plan. Length of the work year and hours of employment shall be established by the District.

Performance of the job will be evaluated in accordance with provisions of the School Board’s policy on evaluation of personnel.

Nothing in this job description restricts management’s right to assign or reassign duties and responsibilities to this job at any time.

Pasco County Schools will provide reasonable accommodations to qualified individuals with disabilities to allow them to perform the essential functions of the job when such individuals request an accommodation.

Claims Specialist;   EST: October 16, 2013 ;   REV: June 23, 2020;   Board Approved: October 16, 2013