University of Rochester Human Res Rep I - Leave Admin in Rochester, New York
Full Time 40 hours Grade 051 HR Admin Svc & Employment
8 AM-5 PM
*General Purpose: *
Serves as a resource for all levels of University staff including faculty, staff, supervisors, managers, union reps, payroll and HR Business Partners regarding Workers’ Compensation law, policy and procedures. Has a working knowledge of all leave programs with the ability to answer basic questions regarding Family Medical Leave (FMLA), Time Away (PTO/Sick Time, Vacation), Leave of Absence (LOA), Short Term Disability (STD), Long Term Disability (LTD) and Paid Family Leave (PFL) programs. Promotes the HR Experience through the HR Values of Respect, Integrity, Inclusion, Performance Excellence and Engagement. Consistently demonstrates the 15 HR Experience Behaviors categorized under the five dimensions of ‘One Inclusive Team, Performance Excellence, Leading with Integrity, The HR Experts and Valued Customer Resource’,
Under general direction but with latitude for exercise of independent judgment within established guidelines serves as a subject matter expert for the Workers’ Compensation program.
Counsels and serves as a resource for faculty, staff, supervisors, managers, labor relations, payroll, intercessor, and HR Business Partners as to the Workers’ Compensation laws, policies and procedures. Develops claim management strategies and solutions along with the supervisor and follows up with employee, department, Third Party Administrators as appropriate. As necessary, obtains special information or help from, or refers individuals to, other sources of assistance and counsel within or outside the University (physician offices, vendors, intercessor or legal counsel, for example).
Ensures the initial workers’ compensation claim investigation process is complete, assists where needed, including OSHA recordability determination. Reviews and interprets medical information, analyzes, and make decisions on medical certification forms and leave request forms. Independently approves and/or controverts WC claim based on relevant medical information, incident report and knowledge of regulations. Questions provider documentation if unclear or insufficient. Determines approval and/or controverted claims. Directs the vendor on case management strategies.
Interprets regulation and policy. Understands the regulations to ensure documentation and records adhere to regulatory requirements. Monitors Worker/ Compensation Board Notices to assure appropriate, timely actions taken. Monitor claims for case management triggers to direct claim strategy.
Monitor, implement and track Workers’ Compensation LTD process. Run reports and oversees pharmacy vendor performance, appropriateness and assists with special projects. Pulls Independent Medical Exam (IME) reports and cover letters from TPA to ensure timeliness and accuracy of requests and direct appropriate actions. Prepares for vendor meetings, identifies cases to review and compiles legal record requests internally and externally.
Responds to requests in a timely manner; advises departments of results, adjusts discrepancies and resolves special problems. Performs reconciliation and fund transfers to TPA. Reconciles Workers’ Compensation budget and ensures payment and credits are on time and within contracted rates. Develops analytics and presentations for finance and senior leaders.
Describes options, regulations, special procedures or administration actions under the University leave program to meet the needs of the employee and the department.
Recommends updates/changes to leave policies and instruction materials. Provides training as needed in individual or group settings.
Prepares special reports, including recommendations for accommodation of individual problems or adjustment as needed. Observes operation of leave program and reactions of individuals to it.
Maintains working knowledge of all applicable regulations and policies.
Bachelor's degree in the areas of Business Administration, Human Resources Administration, Medical Coding or related fields, and 1 year of related experience in leaves and insurance; or an equivalent combination of education and experience.
EOE Minorities/Females/Protected Veterans/Disabled
Job Title: Human Res Rep I - Leave Admin
Location: Central Administration
Job ID: 209858
Full/Part Time: Full-Time