Description
Job Summary:
The HR Claims Administrator is responsible for managing the end-to-end process(es) for all employee leave programs while ensuring compliance with federal, state and local leave laws, as well as city policies and collective bargaining agreements. In addition, the role will work closely with management to ensure compliance with required training. This position is expected to exercise considerable independent judgment in the investigation, evaluation and adjudication of claims within settlement authority. Performs related work as apparent or assigned under the limited supervision of the Human Resources Director.
Qualification Requirements:
To perform this job successfully, an individual must be able to perform each essential function satisfactorily. The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable an individual with disabilities to perform the essential functions.
Essential Functions:
Directly and independently manage leaves of absence programs ensuring compliance with Family Medical Leave (FMLA), Sickness & Accident Leave (Short Term Disability), Paid Parental Leave and other paid and/or unpaid approved leaves including application, certification, documentation review, approval or denial. Provides employees with clear, timely and compassionate support throughout the leave process.
Responsible for managing the city’s self-insured Workers Compensation Program; enters/tracks claims, assists in insurance adjustments, coordinates care with the city’s third-party administrator; maintains claim logs as required by federal and state law, prepares MIOSHA and management claim and accident reports; and maintains records of losses, claims, associated expenses and premiums paid by the City.
Manage coordination of health-related issues, including all employment-related physicals, requests for accommodation under ADA, disability retirements and fitness for duty evaluations.
Serve as primary point of contact for employees and managers on leave eligibility, return to work protocols, medical restrictions, light duty assignments and reasonable accommodation plans.
Work closely with safety and operational teams to review accident and injury reports, investigations, etc.
Ensure accurate tracking of leave balances and timely updates to managers. Administers payroll functions for approved leaves of absence. Maintains compliant documentation and records in accordance with FMLA, ADA, HIPAA, MIOSHA and city policy. Prepares and maintains reports on leave usage, trends and compliance metrics.
Maintain appropriate self-insurance authority, including certification by the State to be self-insured for workers’ compensation.
Manage coordination and compliance with Drug Free Workplace Policy and FMSCA Drug and Alcohol Policy, acting as the Designated Employer Representative and Program Manager.
Assist with new hire on boarding as needed.
Partner with Organizational Development, Legal, HR and department leaders to provide administrative oversight and support for various training programs (e.g. anti-discrimination, harassment, workplace violence, compliance and ethics, city policy, etc.).
Maintain confidentiality of employee information and uphold HR compliance standards. Support HR projects as needed and perform backup functions to department peers.
Requirements
Knowledge, Skills and Abilities:
Must be able to demonstrate direct experience in managing and operational oversight of Risk Management programs (workers’ compensation, disability, FML, etc.).
Knowledge and experience with all applicable state and federal regulations regarding workers compensation, FMLA, ADA, HIPAA, DOT and state-specific regulations.
Must have the skill and ability to perform a variety of duties, often changing from one task to another of a different nature maintaining a high degree of confidentiality and integrity of the work.
Manage complex problems or cases while making effective decisions independently, meeting compliance deadlines, and follow-up assignments in a timely manner.
Perform research, gather and analyze data and prepare clear, complete, and concise communications and reports. Communicate clearly and effectively in oral and written form, using correct grammar and spelling.
Minimum Qualifications:
Bachelor’s degree in Human Resources, Risk Management, Business Administration or related field. In the absence of a degree, a minimum of five (5) years’ experience in an equivalent role is required.
At least three (3) years of prior claims experience in managing leave of absence and Workers Compensation programs.
Excellent communication skills, both written and verbal.
Strong organizational and record keeping skills with attention to detail and accuracy.
High level of professionalism, discretion and customer service orientation.
Valid driver’s license.
Preferred Qualifications:
PHR or SHRM-CP certification.
Experience with administering benefits in conjunction with collective bargaining agreements.
Certified Workers’ Compensation Professional Designation.
