Workers' Compensation Specialist

GENERAL DESCRIPTION OF WORK:

The Workers’ Compensation Specialist is responsible for the day-to-day administration of VIA’s Self-Insured Workers’ Compensation Program. This role provides technical expertise in claims handling, compliance, and return-to-work coordination in accordance with Texas Department of Insurance Division of Workers’ Compensation (TDI-DWC) regulations, federal law, and VIA policies. The Specialist serves as a liaison with employees, supervisors, medical providers, VIA’s Workers’ Compensation Third Party Administrator (TPA), Health Care Network (HCN), attorneys, and regulatory agencies to ensure claims are managed accurately, timely, and cost-effectively.

ESSENTIAL FUNCTIONS:

Performs and monitors VIA’s Workers’ Compensation Program in compliance with TDI-DWC rules, federal requirements, and VIA policies.

Performs, monitors, and assigns work to Benefits Support staff regarding VIA’s Transitional Duty Program, the Pregnant Workers Fairness Act, preparation of Bona Fide Offers of Employment, and assignment of modified duties.

Communicate with employees, supervisors, providers, and attorneys to resolve questions and ensure efficient claim management.

Conduct investigations of alleged work-related injuries, including gathering documentation, reviewing video evidence, and obtaining witness statements.

Serve as primary contact with VIA’s TPA and HCN to ensure proper claims handling, medical treatment coordination, and contract compliance.

Prepare required forms and reports, including First Reports of Injury (DWC-1), Supplemental Reports (DWC-6), and CMS Mandatory Reporting.

Assist with reconciling monthly Workers’ Compensation loss payments and assist with budget monitoring and account replenishment.

Assist with the preparation of reports and data analysis to evaluate claim trends, costs, and program performance.

Maintain accurate records for reporting, auditing, and compliance purposes.

Provide training and guidance to supervisors and staff regarding Workers’ Compensation procedures and return-to-work processes.

Represent VIA at TDI-DWC hearings, committee meetings, and other proceedings as required.

Maintain confidentiality of employee medical and personal information at all times.

This job description excludes marginal functions that are incidental to performing the job. Other duties may exist.

EDUCATION AND EXPERIENCE:

Bachelor’s Degree in Human Resources, Business Administration, Risk Management, or related field and three (3) years of experience in Texas Workers’ Compensation claims administration. Experience may be substituted in lieu of education on a year-for-year basis up to four years.

PREFERRED QUALIFICATIONS:

Worker’s Compensation Adjuster’s License or Texas All-Lines Adjuster’s License.

ADDITIONAL REQUIREMENTS:

Strong knowledge of TDI-DWC rules, regulations, and reporting requirements.

Ability to analyze claims, conduct investigations, and prepare accurate reports.

Excellent oral and written communication skills; able to interact tactfully and credibly with employees, providers, attorneys, and regulators.

Proficiency in Microsoft Office Suite (Word, Excel, Access) and claims-related databases.

Valid driver’s license with a good driving record; ability to travel to accident sites and hearings as required.

Must maintain confidentiality and comply with HIPAA requirements.

Bilingual skills preferred.

Must be able to maintain good work attendance.

Safety Accountability Statement:

• Employees must consider safety in all tasks performed, as well as demonstrate safe judgment and decisions that not only maintain their own safety; but that of fellow employees and customers.

• Demonstrate a professional commitment to assure compliance with all organizational policies, practices, and programs related to safety, health, and system security.

• Employees have a responsibility to identify and report hazards, as well as potentially unsafe conditions, to your immediate supervisor or Safety Department.

• Employees are responsible, a nd required , to stop a job/task to prevent an unsafe incident or act from occurring. This acknowledges the threat of potential injury, property damage and the opportunity for better judgment to be used.

Must comply with and support all applicable VIA EEO Policies and Procedures.

PHYSICAL REQUIREMENTS:

Physical ability required to be mobile, bend, stoop, stand, reach and lift objects weighing 5-25 pounds such as files, supplies, equipment and large heavy reference manuals and books.

WORK ENVIRONMENTS:

Works in normal office environment with occasional field work at accident or hearing sites.

Occasional irregular hours.

VIA is an Equal Employment Opportunity Employer, providing equal opportunity to all qualified individuals, regardless of race, color, religion, age, sex, national origin, veteran status, genetic information, or disability.