Worker’s Compensation & Risk Specialist

Administers the City’s workers’ compensation program and supports overall risk-management activities. The role manages workers’ compensation claims from first report through closure, partners with internal stakeholders and third-party administrators (TPAs), analyzes loss trends, and implements strategies to reduce occupational injuries, insurance costs, and organizational exposure. The role assists with tracking certificates of insurance and contractual insurance requirements and assists with all risk related liability claims. *The following duties are normal for this position. The omission of specific statements of the duties does not exclude them from the classification if the work is similar, related, or a logical assignment for this classification.* Receive and triage First Reports of Injury (FROIs); file claims with carrier/TPA within statutory time frames. Act as primary liaison among injured employees, managers, medical providers, and insurance representatives. Monitor claim status, reserve levels, and return-to-work (RTW) plans; escalate complex cases. Coordinate light-duty/modified assignments in compliance with the Americans with Disabilities Act (ADA), state laws, and collective bargaining agreements (if applicable). Attend claim reviews, mediations, hearings or depositions; prepare documentation and testimony. Audit carrier/TPA performance, invoices, and loss runs; reconcile payments, subrogation recoveries, and settlements. Analyze loss trends, calculate Experience Modification Rates (EMR), and forecast reserves for budgeting. Review payroll report information to ensure accuracy of worker’s compensation codes. Administer the City’s random and post-accident drug testing processes. Administer the safety equipment reimbursements. Develop and coordinate training programs to improve communication and understanding of the City’s Workers Compensation, FMLA and Risk Programs. Track certificates of insurance and contractual insurance requirements. Assist with the processing of liability insurance claims. Serves as primary resource for FMLA; prepares and responds to FMLA requests Performs other related tasks as required. High School Diploma or equivalent. Bachelor’s degree in Risk Management, Public Administration, Business Administration or related field is preferred. Minimum two (2) years of experience in the administration of worker’s compensation, claims adjusting, or other area within risk management. Considerable knowledge of the clerical procedure involved in the processing of workers' compensation. Knowledge of medical terminology in the review of diagnostic and treatment records A comparable amount of training or experience may be substituted for the minimum qualifications. The City of Coral Gables is an Equal Opportunity Employer/Drug Free Workplace.