Risk Management Specialist - Risk Management

License and Certification Qualifications: Workers' Compensation Professional certificate preferred.

Education Qualifications: High school diploma or equivalent required. Bachelor's degree in related field preferred.

Experience Qualifications: Five years experience in Property and Casualty Insurance and Workers' Compensation required.

Skills Qualifications: Ability to complehend and apply complex insurance and Workers' Compensation regulations; ability to complehend and apply complex insurance policy language; ability to represent Gwinnett County Public Schools in a positive and professional manner when interacting with claimants, lawyers, judges, mediators, medical professionals, and vendors; ability to work both independently and collaboratively; ability to work across functional boundaries and interact with employees at all levels of the organization; ability to exercise independent judgment and deal with problems with both concrete and unknown variables; ability to react effectively to changes in daily priorites; effective communication skills both written and verbal; ability to read and cmprehend simple instructions, short correspondence, and memos; ability to wrtie simple correspondence; strong computer skills including MircoSoft Office Suite; basic mathematics skills.

Primary Responsibilities: Work closely with the Risk Manager to implement the insured and self-insured Workers' Compensation, Student Accident, and Property and Casualty programs for the Gwinnett County Public Schools (GCPS) Risk Management Department, to include reviewing, examining, investigating, and analyzing Workers? Compensation, fleet, property, and general liability claims and handling claims that vary in complexity from inception to end, This position also provides information and assistance to the district's personnel, injured employees, claims administrators, vendors, and medical and legal professionals.

1. Investigate, examine, analyze, and review Workers' Compensation claims.
a. Interact with injured employees to ensure awareness and understanding of the Workers' Compensation process, requirements, and entitlements.
b. Organize medical treatment for injured employees and provide information to treating physicians regarding employees’ medical history, health issues, and job requirements.
c. Serve as a liaison between medical providers, employees, legal professionals, vendors, and school district.
d. Communicate with the Human Resources Department regarding benefit payments to injured workers.
e. Coordinate with school administration, staffing directors, and the Human Resources Department regarding injured employees' work restrictions and coordinate appropriate accommodations for returning to work.
f. Review and interpret doctors' reports to ensure that the appropriate American Medical Association (AMA) guidelines have been applied when reporting disability, impairment, and appropriation.
g. Negotiate medical and property expenses with vendors, medical providers, and claimants to be paid by the school district.
h. Identify subrogation potential and pursue the process of reimbursement.
i. Communicate with defense attorneys regarding litigated cases, make recommendations regarding proposed settlements, and attend hearings and mediations when needed.
j. Interpret and apply pertinent federal, state, and local codes, law, regulations and AMA and FMLA guidelines.
k. Maintain a record of Panel Physician performance issues and make recommendations regarding the makeup of the panel.



2. Investigate, examine, analyze, and review fleet, property, and general liability claims.
a. Determine insurance coverage by examining claims forms, policies, and other records; determine applicability of claim against insurance policies.
b. Interview claimant and witnesses, consult with police and hospital/doctors records, and inspect property damage.
c. Serve as a liaison between employees, legal professionals, vendors, and school district and coordinate with applicable departments in gathering needed information to process payments and reimbursements.
d. Settle claims by determining insurance liability and reach agreement with claimant within policy provisions.
e. Identify subrogation potential and pursue the process of reimbursement.
f. Establish claim reserves by estimating the cost of the assigned claim and monitor reserves and update amounts as necessary.
g. Communicate with defense attorney regarding litigation cases and make recommendations regarding proposed settlements.
h. Prepare, process, and submit claims to the excess insurance carrier for consideration.
i. Assist in seeking recovery for damages to district property.
j. Assist in financial reporting for the department.



3. Assist the Risk Manager with coordination of the School Board Insurance program.
a. Maintain current policies, riders, and endorsements
b. Consult with broker to implement the bid process for annual renewal process.
c. Coordinate receipt of bid packages for market assignment and award.
d. Compile financial and statistical data for the insurance bid process.
e. Process insurance renewals and policy premiums.
f. Provide coverage information to Board employees as necessary.
g. Maintain recourse of system inspections, maintain district property values and contractor's equipment list.

4. Implement and maintain approved vendor contracts and certificates of insurance for charter bus complies for school use.


5. Coordinate annual enrollment for the Student Insurance program, to include vendors, pamphlets, and school website links. Coordinate with athletic coordinators and coaches on the program for our student athletes.


6. Process required state Workers' Compensation and insurance forms
a. Coordinate medical services for injured workers.
b. Maintain and update required risk management records.
c. Process and adjust Workers' Compensation claims
d. Communicate and coordinate claim benefits with employee, supervisor, physician, lawyer, other district departments, insurance companies, and third party administrators.
State Reporting

7. Perform other duties as assigned.

Physical Demands:
While performing the duties of this job, the employee is frequently required to sit for extended periods of time. Employee is also required to talk, hear, stand, and walk. The employee may be required to use hands to touch, handle, feel, and/or reach. Employee is occasionally required to stoop, kneel, or crouch. The employee must occasionally lift and/or move up to 25 pounds. Specific vision abilities required by this job include close vision, distance vision, color vision, depth perception, and ability to adjust focus. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.