1 South Australia Police POSITION INFORMATION DOCUMENT Stream : Administrative Services Career Group : Consultancy and Information Discipline : Classification : ASO3 Command : Human Resources Service Position Title : Claims Management Officer LEVEL CHARACTERISTICS The position has been classified at the Administrative Services level 3 by virtue of the requirement to; - provide a level of practical skills and expertise in claims management - possess a sound knowledge and understanding of claims management practices and procedures - exercise responsibility and judgement for the delivery of a function (determining low and medium risk claims) - prioritise workloads. POSITION SUMMARY The Claims Management Officer is required to provide support to the Claims Manager to assist with the effective and efficient administration and management of workers compensation claims. The Claims Management Officer is responsible for the administration and management of workers compensation claims within established delegated criteria. The Claims Management Officer is required to manage, administer, review, determine and calculate entitlements for medium to low risk workers compensation claims. This includes providing recommendations of appropriate levels of lump sum payments for non-economic loss. POSITION CHARACTERISTICS The South Australia Police (SAPOL) provides a diverse range of services to the community. These services are aimed at producing a safe and peaceful environment by the minimisation of crime and disorder. It is a large complex organisation which, because of the nature of its operations, is constantly subject to public scrutiny and accountability. It provides services to a range of different locations spread across the State on a 24 hour a day basis. The Injury Management Services is part of the Health Safety and Welfare Branch which is one of the multiple branches forming the Human Resources Service within SAPOL.
2 The Health, Safety and Welfare Branch, provides the organisation with programs, policy guidelines and advice on a comprehensive range of services which relate to management of human resources in the fields of medical, psychology, welfare, chaplaincy, rehabilitation, claims management and occupational health and safety functions. Many of these functional services are structured to provide an emergency response/crisis management role on a 24 hour a day basis. In that capacity the specialist sections relate closely to the police managers accountable for that function or area across the whole of South Australia. Injury Management Services is primarily responsible for the provision of vocational rehabilitation and claims management services to SAPOL work injured employees. Injury Management Services also provides advice and assistance with the management of non-compensable injuries or illness as requested. The Claims Management Officer is accountable to the Claims Manager for contributing to the provision of an effective and efficient workers compensation claims management service within Injury Management Services. The Claims Management Officer is required to manage, administer, review, determine and calculate entitlements for medium to low risk workers compensation claims. This also includes providing recommendations of appropriate levels of lump sum payments for non-economic loss. The Claims Management Officer is responsible for calculating notional weekly earnings and salary entitlements of injured workers receiving compensation benefits and subsequently entering this information into SAPOL s Human Resource Management System (HRMS). The Claims Management Officer is also responsible for approving and updating the Injury Management database (SIMS) with salary and creditor information. The Claims Management Officer is responsible for preparing, analysing, monitoring and reviewing all claims in accordance with the Workers Rehabilitation and Compensation Act, WorkCover Performance Standards for Self Insurers and SAPOL s Injury Management Work Instructions. The Claims Management Officer will be required to provide advice to injured employees, their supervisors and attend case conferences with Return to Work Coordinators as requested. The ability to communicate effectively both verbally and in writing with a broad range of people regarding complex, confidential and sensitive information is required. ORGANISATION Supervisor Reports to: Supervisor's Position: Subject Position: Staff Supervised: Senior Case Manager, Injury Management Services Claims Manager Claims Management Officer Nil Other Positions Reporting to the Supervisor: 1 x Claims Consultant 2 x Claims Management Officer 2 x Claims Administrator 1 x Claims Assistant
3 South Australia Police JOB AND PERSON SPECIFICATION Title of Position : Claims Management Officer Classification Code : ASO3 Position Number : Position Created : / / Type of Appointment : Ongoing Service : Human Resources Service Branch : Health Safety & Welfare Section : Injury Management Services Job & Person Specification Approval (for all positions excluding senior positions)... / / Commissioner of Police or Delegate P.C.O. Reference Number JOB SPECIFICATION 1. Summary of the broad purpose of the position, and its responsibilities / duties. The Claims Management Officer is required to provide support to the Claims Manager to assist with the effective and efficient administration and management of workers compensation claims. The Claims Management Officer is responsible for the administration and management of workers compensation claims within established delegated criteria. The Claims Management Officer is required to manage, administer, review, determine and calculate entitlements for medium to low risk workers compensation claims. This includes providing recommendations of appropriate levels of lump sum payments for non-economic loss. 2. Reporting / working relationships (to whom the person reports, staff for whom the person is responsible and other significant connections and working relationships within the organisation) The Claims Management Officer reports to the Claims Manager and is required to work closely with other claims staff, Data Analyst and Return to Work Coordinators within Injury Management Services. The Claims Management Officer will also be required to liaise with other members of the Health Safety and Welfare Branch, Human Resources Management Branch and Payroll Services. 3. Special Conditions (Such as non-metropolitan location, travel requirements, frequent overtime) Some out of hours work may be required. May be required to act in other positions. The incumbent may be required to enter into an annual performance agreement for the achievement of (specific or service or program) outcomes.
4 4. Statement of Key Outcomes and Associated activities (Group into major areas of responsibility and list in descending order of importance) Assist in the provision of an effective and efficient workers compensation claims management and administration service to SAPOL employees in accordance with the requirements prescribed by the Workers Rehabilitation and Compensation Act 1986, Regulations, WorkCover Performance Standards for Self Insurers and SAPOL s Claims Management Manual by: Assessing and determining all medium to low risk claims, including reviewing claims, seeking medical reports and or additional documentation for determination. Assisting in the risk streaming of new claims upon receipt and ensuring immediate referral to Return to Work Coordinator for initial rehabilitation assessment. Maintaining regular communication and conducting early case conferencing with new workers compensation claims with relevant parties such as treating practitioners, Return to Work Coordinator, HR, Employee Assistance Service (EAS) and legal / industrial practitioners as appropriate to prevent new claims from becoming long term and or high risk. Providing advice and informing claimants, medical practitioners, supervisors and managers, of their rights and obligations and maintaining regular contact with injured employees in relation to their claim, including notification of claim deferrals. Conducting quarterly and yearly reviews on all claims in accordance with the legislation. Ensuring the timely payment of salaries and accounts by calculating and determining salary and medical/rehabilitation expense entitlements. Assisting with recovery actions where a third party is liable by identifying those claims where there is eligibility for third party recovery and corresponding with relevant bodies such as Compulsory Third Party Provider (CTP). Ensuring that computerised systems are maintained by entering and updating information as required on the injury management (SIMS) and HRMS payroll system. Assisting with the determination of Section 43 lump sum payments for non-economic loss. Assisting the Claims Manager to prepare for Tribunal hearings and liaising with the Crown Solicitors Office. Providing advice to the Claims Administrator and Claims Assistant and assist with training and induction of new claims staff. Assisting in the effective and efficient operation of the Claims Management Unit by working as a team member to achieve the objectives of Injury Management Services. Contribute to the effective management of staff within the unit by ensuring that: Team members are afforded equal employment opportunity in accordance with the principles of equity and diversity; Team members are managed in accordance with SAPOL s Occupational Health and Safety policies and relevant legal requirements; and
5 A harmonious workplace free of unlawful discrimination, sexual harassment and bullying is maintained. Certified correct by Manager/Branch Head :... / / Acknowledged by Current Occupant :... / / Name of Current Occupant :...
6 PERSON SPECIFICATION Essential Minimum Requirements (Those characteristics considered absolutely necessary.) Educational / Vocational Qualifications (Include only those listed in Commissioner's Standard No. 2 as an essential qualification for a specified group.) Nil Personal Abilities/Aptitudes/Skills (Related to the job description, and expressed in a way which allows objective assessment.) Ability to determine priorities and organise workloads and to meet deadlines, often in an environment of competing demands and high volumes of work. Proven ability to work independently and display initiative without close supervision. Proven ability to work effectively as a team member and foster good working relationships. Possess sound verbal and written communication skills that enable effective and appropriate communication with a broad range of people. Ability to analyse problems and formulate a practical course of action. Demonstrated effective consultation and conflict resolution skills. Proven ability to act with integrity and maintain confidentiality in dealing with issues of a sensitive nature. Ability to assist in the training and development of team members. Possess a high level of personal integrity and credibility and maintain confidentiality. Demonstrated ability to contribute to the maintenance of a harmonious, safe and healthy workplace, free of harassment, unlawful discrimination and bullying and where diversity is valued. Experience (Including Community Experience) Experience in workers compensation claims management and payroll procedures. Experience in the interpretation and analysis of legal documents including Acts of Parliament. Experience in the preparation of letters, medical report requests and general correspondence. Experience in organising and managing case workloads. Experience in the use and maintenance of a compensation data base. Knowledge Working knowledge and understanding of the Workers Rehabilitation and Compensation Act 1986, associated regulations and the WorkCover Performance Standards for Self Insurers.
7 Knowledge and understanding of the functions of a payroll service. Knowledge of the principles of equity and diversity requirements. Desirable Characteristics (To distinguish between applicants who have met all essential requirements) Educational / Vocational Qualifications (Considered to be useful in carrying out the responsibilities of the position) WorkCover Accreditation in Claims Management or accredited provider eg: TAFE Personal Abilities/Aptitudes/Skills Ability to make clear decisions and exercise sound and consistent judgement. Experience Experience in the use of SIMS workers compensation and information management system or a similar data base. Experience in the use of Microsoft Office software. Experience in Government accounting procedures. Experience in the payment of accounts and /or salary. Experience in case management and attending case conferences. Knowledge Knowledge of medical and legal terminology. Knowledge of the structure and function of SAPOL. Knowledge of SAPOL s Human Resource Management System. Knowledge of the principles and practices of case management
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