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Workers' Compensation Administrator

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Workers' Compensation Administrator

Salary

$50,633.00 - $88,607.00 Annually

Location

Wake County, NC

Job Type

Permanent Full-Time

Job Number

25-06399

Department

Dept of Transportation

Division

Human Resources

Opening Date

05/20/2025

Closing Date

5/30/2025 11:59 PM Eastern

Job Class Title

Program Coordinator IV

Position Number

60027675

Salary Grade

NC14

+ Description

+ Benefits

+ Questions

Description of Work

This is an anticipated vacancy.

Salary Range for this position is $50,633 to $88,607

This position has a lead role in managing workers’ compensation claims. The WCA works closely with the state’s third-party administrator (TPA) to ensure compliance with the contract and timely and appropriate care is provided. The WCA approves the official creation of a claim and participates in the decision to accept or deny all claims. This position will enter a form 19, fill out a form 22, and other forms when it is required to meet deadlines. Otherwise, their role in the forms is to provide information, training, and guidance to clerical staff to complete forms. Failure to complete forms accurately and in time can introduce financial risk for the department, increase the likelihood of a claim being contested, and other time-consuming or financial consequences to the department. The timeliness of this work is accomplished by setting priorities and without supervision.

Once a claim is accepted, the WCA provides oversight to the TPA staff, ensures good communication with the employee, supervisors, and others as needed. The WCA is responsible for monitoring costs and making decisions regarding closing claims. The employee works closely with unit supervisors to develop scenarios for return to work.

The position plays a central role when there is conflict involving a claim. The WCA may work directly with an injured employee, the injured employee’s lawyer, and with Attorney General staff members, that represent the state in these matters. The position will participate in decisions made for vocational rehabilitation and will keep Human Resources staff informed on cases that may require some employment-related action. This position must exercise good judgement regarding elevating the discussion of cases out of the hundreds that are open at any one time. This requires an appreciation for organizational dynamics and financial risks.

This position must be able to work in large database systems to research records, get answers to questions, and verify correct billing. The WCA will assemble case files for attorneys and management reviews. The inability to prepare proper records can result in cases being lost during mediation or at hearings. The failure to execute these tasks accurately can result in fines from the Industrial Commission and losing at hearings. Preparation is accomplished with minimum supervision.

This position requires: knowledge of NC Workers' Compensation Act, skill in handling insurance claims, familiarity with medical terminology, the ability to work with doctors, attorneys, supervisors and hostile/agitated employees/families, the ability to use case records software, the ability to use a personal computer to access data, the ability to read and interpret General Statutes regarding Workers' Compensation case law and Opinions and Awards, and the ability to give adequate testimony regarding the NCDOT's position in litigated claims.

The position will attend Workshops, conferences and conventions of the disability industry, which provide additional training or Continuing Education credits along with attending ordered mediation, three-way telephone or final hearings on disputed claims, including giving sworn testimony. Team with attorneys from the Attorney General's office in trial preparation, which would include witness lists, review medical records, and apply the appropriate sections of the General Statutes regarding the defenses' position in the litigation process. In addition, the position is responsible for providing plaintiff's attorneys with discovery material prior to litigation, and throughout the lifetime of the claim. Routinely accepts or denies agency liability for Workers' Compensation claims filed in accordance with GS-97. Investigate and then prepare documentation for support denials or contested cases.

Preparation of claims for litigation purposes as well as appearance at court actions and ordered mediation as sole authority to act for the Department of Transportation. Negotiate and approve settlements and subrogate against third parties for reasonable recoveries.

Respond to inquiries from within the Department and from outside sources as to policy and procedures in relation to Workers' Compensation. Responses may be in written form or oral presentations.

Prepare input of the annual claim liability and one-year accrual report. This function requires the addition and deletion of all Workers’ Compensation claims for which the Department will have liability for indemnity payments through the next fiscal year. Types of indemnity payments include Death Claims, Permanent Partial, and Permanent Total (lifetime benefits).

Employees serve as part of a team to develop policies and procedures and contribute to the smooth workflow of the section. Smooth workflow of the Section is an ultimate responsibility including interaction with the North Carolina Industrial Commission, Attorney General's Office, DOT managers, injured employees and their families. DOT management and field staff, medical providers and rehabilitation vendors.

Assist, evaluate and ensure proper training of section employees. Assistance is not limited to annual performance reviews but includes intervention and application of established personnel procedures to resolve internal conflicts.

The program area for this position includes one or more of the following: working knowledge of workers compensation claims processing, working knowledge of workers compensation database programs, experience preparing workers compensation claims for litigation, and/or working knowledge of North Carolina workers compensation rules and policies.

Knowledge, Skills and Abilities / Competencies

Applicants must submit an application that clearly reflects work experience that demonstrates the following:

+ Working knowledge of state and federal law, administrative rules, regulations and procedures applicable to North Carolina workers' compensation claims (interpreting, explaining, and applying policies, procedures, and regulations).

+ Demonstrated ability in establishing and maintaining effective working relationships with a variety of associates, legislators, medical professionals, other public officials, and/or the public.

+ Experience attending ordered mediation, three-way telephone or final hearings on disputed claims, including giving sworn testimony.

+ Experience handling insurance claims, including familiarity with medical terminology.

+ Working knowledge of MS Office products (Word, Excel, PowerPoint, Outlook).

Minimum Education and Experience Requirements

Some state job postings say you can qualify by an “equivalent combination of education and experience.” If that language appears below, then you may qualify through EITHER years of education OR years of directly related experience, OR a combination of both. See oshr.nc.gov/experience-guide for detail.

Bachelor’s degree from an appropriately accredited institution and three (3) years of experience related to the area of assignment; or an equivalent combination of training and experience.

Supplemental and Contact Information

Kayla A Pope - 919-634-5788

It is important that your application includes all your relevant education and work experience and that you answer all questions associated with the application. NCDOT will not accept “See Attached” or “See Resume” in lieu of education and work experience completed on the application. If multiple applications are submitted to an individual posting, only the most recent application received prior to the posting date will be accepted.

NOTE: For temporary, contract or other supplemental staffing appointments: There are no paid leave, retirement or other benefits associated with these appointment types.

For permanent and time-limited appointments:

Eligible employees have benefits that include employee health insurance options, standard and supplemental retirement plans, NC Flex (a variety of high-quality, low-cost benefits on a pre-tax basis), and paid vacation, sick, and community service leave, to name a few. Paid parental leave is available for eligible employees. Some benefits require 30 + hours work/week for participation.

01

I understand in order to be qualified for this position, the description of my work experience must clearly reflect the required education and experience as well as the posted knowledge, skills and abilities for this position. I have included all of this information within my application. (If you haven't completed the application requirements, please return to your application to finish it before submitting your application.)

+ Yes

+ No

02

Which of the following best describes your level of working knowledge of state and federal law, administrative rules, regulations and procedures applicable to North Carolina workers' compensation claims (interpreting, explaining, and applying policies, procedures, and regulations)?

+ None

+ Basic

+ Intermediate

+ Thorough

03

Explain how you have working knowledge of state and federal law, administrative rules, regulations and procedures applicable to North Carolina workers' compensation claims (interpreting, explaining, and applying policies, procedures, and regulations).

04

Which of the following best describes the level of ability you have demonstrated establishing and maintaining effective working relationships with a variety of associates, legislators, medical professionals, other public officials, and/or the public?

+ None

+ Basic

+ Intermediate

+ Thorough

05

Explain how you have demonstrated the ability to establish and maintain effective working relationships with a variety of associates, legislators, medical professionals, other public officials, and/or the public.

06

Which of the following best describes your level of experience attending ordered mediation, three-way telephone or final hearings on disputed claims, including giving sworn testimony?

+ None

+ Less Than 1 Year

+ 1-2 Years

+ 2-3 Years

+ 3 or More Years

07

Explain how you have experience attending ordered mediation, three-way telephone or final hearings on disputed claims, including giving sworn testimony.

08

Which of the following best describes your level of experience handling insurance claims, including familiarity with medical terminology?

+ None

+ Less Than 1 Year

+ 1-2 Years

+ 2-3 Years

+ 3 or More years

09

Explain how you have experience handling insurance claims, including familiarity with medical terminology.

10

Which of the following best describes your level of working knowledge of MS Office products (Word, Excel, PowerPoint, Outlook)?

+ None

+ Basic

+ Intermediate

+ Thorough

11

Explain how you have working knowledge of MS Office products (Word, Excel, PowerPoint, Outlook).

Required Question

Employer

State of North Carolina

Website

http://www.ncdot.gov/

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