2H27

PAY RANGE:  N17

EMPLOYEE DISABILITY ADMINISTRATOR

GENERAL DEFINITION

        This is administrative employee disability related work overseeing a major department wide injured on duty program.   Employees in this class collect and analyze data, track cases, provide information on legal requirements and guidelines, prepares reports and provide depositions and testimony in support of case management and claims processing.  Employees serve as the primary contact and expert in  the injured on duty program.   Employees also participate in the development and administration of training in the subject area with an emphasis on legal requirements.  Significant aspects of this work include limiting liability to the City and facilitating the expeditious return of employees to full work duty.  The employee initiates investigations as needed and may supervises a small clerical staff.  Work is performed under the direction of a higher-level safety manager.

ALLOCATING FACTORS: (The following conditions must be met in order for  a position to be allocated to this class.)

1. Positions must be responsible for managing a department-wide injury claims program for a major department, characterized by departments with 700 or more employees or based on a review of employee injuries and illness due to strenuous work activity or health exposures.

2. Positions must have responsibility for most, and involvement in all, employee disability related work in the following major City departments:

· Commerce Department's Division of Aviation

· Department of Human Services

· Philadelphia Fire Department

· Philadelphia Parks and Recreation

· Philadelphia Department of Prisons

· Philadelphia Police Department

· Streets Department

· Water Department

· Department of Public Health

· Office of Fleet Management

· First Judicial District

TYPICAL EXAMPLES OF WORK (ILLUSTRATIVE ONLY)

Reviews first report of injury forms to determine appropriateness of information presented; gathers additional information by requesting statements from witnesses, supervisors, and claimants and by requesting medical statements from doctors and medical facilities; assists with determining when independent medical examinations are -necessary for claim approval/denial; makes recommendations.

Provides the City’s third party administrator and the Office of Risk Management facts to determine if a new claim is medical-only, if it is a compensable lost-time claim, or if denial of claim is recommended; establishes files for medical-only claims and for compensable loss claims; documents and tracks actions and timelines; initiates telephone contact or correspondence to periodically follow up on information required in claim compensability determinations; issues policy notifications to claimants; initiates action in response to noncompliance under Regulation 32.

Answers verbal and written inquiries of claimants and other parties to explain legal requirements and procedures which apply to injured on the job claims; notifies claimant and medical service provider of denied billings and claims; initiates subrogation notice to third party for liability.

Works on investigations involving fraud, identifying potential cases and making recommendations regarding the surveillance of fraudulent activities; provides information to investigator as to appropriateness of evidence. 

Collects, compiles and analyzes data; utilizes specialized computerized software programs to produce reports demonstrating statistics and trends and multimedia presentations used in seminars and training; develops and presents injured on the job seminars and injury claims handling training to managers and supervisors on the legal requirements, policies, grievances and interventions.

Manages departmental limited duty placement program; identifies and obtains appropriate assignments; places employees; explains program, policy and duties; assists with resolving grievances regarding work assignments; participates on committees with managers, safety personnel and medical personnel involving claims, appeals and safety issues.

Testifies in court and official city hearings to provide facts and reasoning to support decisions to deny claims; provides necessary documentation, certification, or approval in support of actions.

Provides support services for the department wide baseline medical program, including identifying participants, contacting employees, scheduling appointments, providing information to employees regarding the program, tracking data; prepares written warning notices and suspension notices for non-compliant injured employees.

Supervises a small staff of clerical employees.

Performs related work as required.

REQUIRED KNOWLEDGE, SKILLS AND ABILITIES

KNOWLEDGE OF:

• workers' compensation guidelines and Pennsylvania state laws pertinent to workers' compensation claims
• Civil Service Regulations
• grievance process
• employee disability benefits system
• City of Philadelphia's pension benefits systems or comparable pension plans
• departmental functions, operations, and organizational structure
• interviewing and investigative procedures and techniques
• legal terminology as it pertains to the management of a disability benefits system
• medical terminology
• insurance claims adjusting
• English grammar, spelling and oral communication
• basic arithmetic functions - addition, subtraction, multiplication and division

SKILL IN:

• utilizing standard and specialized computer software packages for tracking data, producing reports and training material

ABILITY TO:

• communicate orally and in writing with managers, claimants, physicians, insurance personnel, and representatives of other governmental agencies
• read, understand and apply state law, workers' compensation court guidelines, City regulations, and other oral and written instructions
• calculate solutions to arithmetical problems involving addition, subtraction, multiplication, division, and percentages
• produce reports and identify trends
• analyze and interpret routine data
• demonstrate judgment and independently make decisions consistent with best practices
• conduct training in area of specialization
• identify problems and make recommendations
• supervise the work of lower-level employees

MINIMUM ACCEPTABLE TRAINING AND EXPERIENCE (The following statement represents the minimum training and experience standards which will be used to admit or reject applicants for tests. Applications submitted by candidates for this class will be reviewed based on training and experience requirements as approved on 6/21.)

EDUCATION:

Completion of a bachelor's degree at an accredited college or university with major coursework in business administration, human resources, safety, health, or related field.

AND

GENERAL EXPERIENCE:

Two years of advanced level clerical or administrative work.

AND
SPECIFIC EXPERIENCE:

Two years of paraprofessional or supervisory administrative experience with a large agency, handling workers' compensation and disability claims.

OR

Any equivalent combination of education and experience determined to be acceptable by the Office of Human Resources, which includes the Specific Experience described above.

PHYSICAL AND MEDICAL REQUIREMENTS

Ability to physically perform the duties and to work in the environmental conditions required of a position in this class.

Class Established:
  CSC - 12/04

Ad. Board - 01/05

Spec. Revision:

CSC – 12/05

Ad. Board – 11/06

Latest Spec. Revision:

CSC – 5/21

Ad. Board – 6/21

SA