_________________________________________________________________________________
South Australia Police
POSITION INFORMATION DOCUMENT
_________________________________________________________________________________
Stream
:
Administrative Services
Career Group
:
Consultancy and Information Group
Discipline
:
Human Resources
Classification
:
ASO5
Service
:
Human Resources Service
Position Title
:
Claims Manager
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LEVEL CHARACTERISTICS
_________________________________________________________________________________
The position has been classified at the Administrative Services level 5 by virtue of the requirement to: work under limited direction;
 exercise initiative, judgement and delegated authority;
 control and coordinate elements of a total agency program;
 provide expert advice, assistance, and consultation to all levels of SAPOL employees and
clients;
 undertake negotiations on matters of significant impact for the agency; and
 apply knowledge from a range of disciplines gained through experience, training and/or
tertiary education.
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POSITION SUMMARY
_________________________________________________________________________________
The Claims Manager is accountable to the Senior Case Manager, Injury Management Services,
Health Safety and Welfare Branch for the provision of an efficient and effective Workers
Compensation claims management and advisory service for SA Police.
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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 (over 100) 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 six
branches forming the Human Resources Service within the South Australia Police.
The Health, Safety and Welfare Branch, provides SAPOL with programs, policy guidelines and advice
on a comprehensive range of services which relate to management of human resources in the fields
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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 Manager is responsible for SAPOL's performance in the management of all workers
compensation claims by ensuring compliance with appropriate Acts and Standards. Included in this
activity are the investigation, assessment, subsequent determination, and the management of claims.
As a result, the Claims Manager is required to have an in-depth working knowledge of all appropriate
legislation and policy covering workers compensation and is expected to provide expert advice and
assistance to employees and management relating to any aspect of the claims management process.
The Claims Manager represents the organisation at the SA Workers Compensation Tribunal and
determines and coordinates legal representation by the Crown Solicitor’s Office where necessary.
The Claims Manager is required to liaise with the legal profession, union representatives and workers,
on matters of significant financial impact to the organisation, such as the negotiation of lump sum
settlements.
In addition, the Claims Manager provides training to all levels of management within SAPOL on the
administration of workers compensation claims to ensure accuracy and timeliness. This training
extends to the development of other claims personnel within Injury Management Services.
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ORGANISATION
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Supervisor reports to:
Manager, Health Safety and Welfare Branch
Supervisor's Position:
Manager, Injury Management
Subject Position:
Claims Manager
Staff Supervised:
Claims personnel x 3
Other Positions Reporting to the Supervisor:
Return to Work Coordinator
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STATISTICS RELEVANT TO THE POSITION
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_________________________________________________________________________________
South Australia Police
JOB AND PERSON SPECIFICATION
_________________________________________________________________________________
Title of Position
:
Claims Manager
Classification Code
:
ASO5
Position Number
:
Position Created
:
Type of Appointment
:
Permanent
Service
:
Human Resources Service
Section
: Injury Management
_________________________________________________________________________________
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 Manager is responsible for coordinating and facilitating the management of workers
compensation claims in accordance with the Workers Rehabilitation and Compensation Act 1986,
SAPOL’s Injury and Absence Management Policy and WorkCover Performance Standards for SelfInsurers.
Assist in the development, implementation, review and improvement of workers
compensation claims management systems, practices, policies and procedures. Provide an expert
advisory, consultancy and training service to managers, supervisors, and employees on the
assessment and administration of claims.
-------------------------------------------------------------------------------------------------------------------------------------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 Manager reports to the Manager, Injury Management, Health Safety and Welfare Branch
and is responsible for the day to day guidance, training and supervision of claims personnel. The
Claims Manager is required to work closely with Return to Work Coordinators, SAPOL managers and
supervisors, Employee Assistance Services, Police Medical Officer, Human Resources Management
Branch and Prevention staff in order to resolve compensation issues and assist injured employees to
return to work.
-------------------------------------------------------------------------------------------------------------------------------------3.
Special Conditions
(Such as non-metropolitan location, travel requirements, frequent overtime)
-------------------------------------------------------------------------------------------------------------------------------------

Some intrastate, overnight travel and out of hours work may be required.
Current drivers licence is essential.
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
The incumbent may be required to enter into an annual performance agreement for the
achievement of (specific or service or program) outcomes.
------------------------------------------------------------------------------------------------------------------------------------4.
Statement of Key Outcomes and Associated activities
(Group into major areas of responsibility and list in descending order of importance)
-------------------------------------------------------------------------------------------------------------------------------------Ensure effective and efficient claims management and administration services to SAPOL
employees who have sustained a work related injury by:








Promptly assessing notification of all work related accidents / incidents received at Injury
Management Services for early intervention assistance and referral to Return to Work
Coordinator/Employee Assistance Services (EAS);
Risk streaming new claims upon receipt and ensuring immediate referral to Return to Work
Coordinator for initial rehabilitation assessment;
Assessing and determining all workers compensation claims including deferral, rejection and
approval, as well as approving ongoing claims for expenditure;
Managing psychological and other complex claims including managing and assessing claims
in accordance with legislative requirements and industry standards, developing appropriate
case management plans with key actions, stakeholders, review dates and expected
outcomes;
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, EAS and legal / industrial practitioners as appropriate to prevent new claims
from becoming long term and or high risk;
Providing expert 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;
Managing long term, complex and/or contentious cases involving severe injury and/or long
term absence from work and ensuring regular and timely review;
Oversighting Section 38, Section 42 and Section 43 processes including the determination of
levels of lump sum payments for non-economic loss and redemption of liabilities according to
the relevant legislation and precedents set by SA Workers Compensation Tribunal.
Ensure that SAPOL meets its statutory and departmental obligations by:





Preparing documentation and representing SAPOL at the SA Workers Compensation Tribunal
hearings;
Arranging legal representation at these hearings including instructing and briefing solicitors;
Negotiating and liaising with a range of parties including SAPOL’s Executive Solicitor, Crown
Solicitor’s Office, the employee’s legal and union representatives and others involved in the
investigation and determination of claims and matters of review, dispute and appeal;
Identifying and initiating recovery of monies from negligent third parties and monitoring and
controlling recovery action;
Determining estimates of potential risk / liabilities associated with workers compensation for
SAPOL and for each individual claim.
Contribute to the reduction of claim numbers and costs in SAPOL by:





Assisting in the analysis of workers compensation trends by reviewing and providing
information to management and prevention staff on workers compensation claims in order to
prevent accident injury reoccurrence;
Developing, implementing and monitoring claims management policies and practices to
facilitate the prompt and efficient management of workers compensation claims;
Ensuring the development and provision of relevant training to management, supervisors and
employees in relation to the claims management function, including training and supervising
claims personnel in claims policies and procedures for the effective management of claims;
Accurately calculating notional weekly earnings and monitoring income maintenance
payments to ensure they are correctly processed;
Implementing and conducting periodic reviews of all claims files to minimise costs and to
expedite the closure of workers compensation claims;
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

Monitoring and reviewing workers compensation performance against Cabinet targets,
SAPOL performance indicators and undertaking corrective action as required;
Initiating investigations through the Commissioner of Police for suspected fraudulent
behaviour.
Ensure a high level of claims management compliance by:





Interpreting and applying the Workers Rehabilitation and Compensation Act 1986, particularly
in relation to claims administration, the level of appropriate benefits and review procedures;
Implementing the WorkCover Performance Standards;
Developing, monitoring, reviewing and evaluating the Internal Audit Program for Claims
Management and undertaking corrective action as required in accordance with the WorkCover
Performance Standards for Self-Insurers;
Coordinating the activities of the claims management service in preparation for external
evaluations;
Overseeing a reconciliation of claim files, IDEAS and financial records of payments with
Transaction Services.
Assist in formulating and implementing strategies and initiatives to improve service delivery
within Injury Management Services by:




Assisting with the setting, implementation and review of objectives for Injury Management
Services and change initiatives to improve the workers compensation claims management
and administration services which are consistent with SAPOL’s OHS & Injury Management
Strategic Plan, DAIS and Crown policy;
Monitoring legislative and policy changes within the fields of injury management;
Liaising with Executive, Managers and staff on issues pertaining to claims management,
rehabilitation and return to work of injured employees;
Undertake research, analyse problems and formulate alternatives. Prepare reports on
specific issues.
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
A harmonious workplace free of unlawful discrimination, sexual harassment and bullying is
maintained.
-------------------------------------------------------------------------------------------------------------------------------------Certified correct by OIC/Branch Head
: .............................................
/
/
Acknowledged by Current Occupant
: .............................................
/
/
Name of Current Occupant
: ......................................
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-------------------------------------------------------------------------------------------------------------------------------------PERSON SPECIFICATION
-------------------------------------------------------------------------------------------------------------------------------------Essential Minimum Requirements
(Those characteristics considered absolutely necessary.)
-------------------------------------------------------------------------------------------------------------------------------------Educational / Vocational Qualifications
(Include only those listed in Commissioner's Standard 2, Appendix 1 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.)
------------------------------------------------------------------------------------------------------------------------------------- Proven written and verbal communication skills congruent with effective performance in a
medical/legal environment.

Ability to analyse complex situations and evaluate alternative actions available.

Ability to motivate, lead and participate as a member of a team and achieve agreed objectives.

Proven ability to negotiate in a clear, concise and effective manner with people of various
backgrounds including legal and medical professionals, and staff at all levels including
management.

Proven ability to determine priorities and organise high volumes of work to meet agreed deadlines
and objectives.

Ability to make decisions under pressure, demonstrate innovative thought and exercise initiative.

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)
------------------------------------------------------------------------------------------------------------------------------------- Demonstrated experience in workers compensation claims administration and case management.

Experience in providing expert advice and consultation services on compensation issues.

Experience in developing and implementing injury management strategies to achieve safe and
successful rehabilitation and return to work outcomes.

Experience in compliance with the WorkCover Performance Standards for Self-Insurers including
the implementation of the audit process.

Experience in WorkCover Tribunal hearings, reviews, conciliations, investigations and litigation
matters.

Experience in the development, delivery and evaluation of training programs.

Experience in the development and implementation of strategies for improved service delivery.

Experience in the development, implementation and evaluation of policies and procedures.
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-------------------------------------------------------------------------------------------------------------------------------------Knowledge
------------------------------------------------------------------------------------------------------------------------------------- Working knowledge and understanding of the Workers Rehabilitation and Compensation Act,
1986, associated regulations, WorkCover Performance Standards for Self-Insurers, SA Workers
Compensation Tribunal and precedent case law.

Knowledge of medical and legal terminology associated with the factors influencing the
management of work related injuries / illnesses

Knowledge of the principles of injury management and best practice strategies.

Knowledge of the principles of Equity and Diversity requirements.

Demonstrated proficient knowledge and commitment to OHS&W legislation, principles and
practices; and risk assessment in accordance with the OHS&W Act (1986), Regulations &
AS/NZS 4360 Standard.
Desirable Characteristics
(To distinguish between applicants who have met all essential requirements)
Personal Abilities/Aptitudes/Skills

Ability to develop, implement and evaluate systems for monitoring client satisfaction.

Ability to initiate options for improved service delivery.
Experience
-------------------------------------------------------------------------------------------------------------------------------------
Experience in case management and developing case management plans.

Experience in dealing with psychological claims.

Experience in developing strategies to resolve long term claims.

Experience in the supervision and training of staff.
-------------------------------------------------------------------------------------------------------------------------------------Knowledge
------------------------------------------------------------------------------------------------------------------------------------- Broad knowledge of Public Sector Management Act and Police Act.

Knowledge of the IDEAS workers compensation database.
Educational / Vocational Qualifications
(Considered to be useful in carrying out the responsibilities of the position)
------------------------------------------------------------------------------------------------------------------------------------- WorkCover Claims Management Accreditation.

Relevant tertiary training and /or qualifications.
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