SENIOR CLAIMS ADJUSTOR

Transcription

1 FLSA Status = Exempt Probation Period = 12 Months Job Code = SENIOR CLAIMS ADJUSTOR Class specifications are intended to present a descriptive list of the range of duties performed by employees in the class. Specifications are not intended to reflect all duties performed within the job. DEFINITION To supervise, assign, review and participate in the work of staff responsible for investigating liability and worker's compensation claims against the City, analyzing and evaluating legal liability and damages, and mitigating, negotiating and settling claims; to ensure work quality and adherence to established policies and procedures; and to perform the more technical and complex tasks relative to assigned area of responsibility. SUPERVISION RECEIVED AND EXERCISED Receives direction from the Unit Manager, Insurance and Claims. Exercises technical and functional supervision over professional staff. ESSENTIAL AND MARGINAL FUNCTION STATEMENTS--Essential and other important responsibilities and duties may include, but are not limited to, the following: Essential Functions: 1. Plan, prioritize, assign, supervise, review and participate in the work of staff responsible for investigating liability and worker's compensation claims against the City, analyzing and evaluating legal liability and damages, and mitigating, negotiating and settling claims; provide technical expertise in functional claim handling; monitor work activities to ensure compliance with field authorities, claim procedures, and established policies and procedures. 2. Establish schedules and methods for providing assigned services; identify resource needs; review needs with appropriate management staff; allocate resources accordingly. 3. Participate in the development of policies and procedures; make recommendations for changes and improvements to existing standards and procedures. 4. Perform the more technical and complex tasks of the work unit including the more technical claim investigations, subrogation, and third-party recoveries; determine the 8/2004

2 necessity of outside expert investigations. 5. Ensure proper imitation of subrogation and consultation of third-party billing. 6. Assist in the assessment and procurement of insurance; evaluate insurance needs; maintain policy records; interact with insurance companies, agents and brokers. 7. Ensure adequacy of reserves. 8. Participate in the selection of staff; provide or coordinate staff training; work with employees to correct deficiencies; implement discipline procedures. 9. Establish and maintain records, files, and historical data. Essential Functions: 10. Respond to public inquiries in a courteous manner; provide information within the area of assignment; resolve complaints in an efficient and timely manner. 11. Attend and participate in professional group meetings; stay abreast of requirements pertaining to claims law, state compensation law, policies, procedures, and benefit and damage assessment methods; ensure Claims Adjusters fulfill educational requirements. 12. Perform related duties and responsibilities as required. QUALIFICATIONS Knowledge of: Operations, services and activities of a claim adjustment program. Principles of supervision, training and performance evaluation. Pertinent Federal, State and local laws, codes and regulations including claims law and state worker's compensation law. Principles and practices of civil litigation. Claim processing and settlement policies and procedures. Negotiating strategies. Principles and practices used in the insurance industry. Principles and practices of evidence preservation. Principles and methods used in cost analysis. Principles and procedures of record keeping and technical report preparation. Modern office equipment including computers and related software. Ability to: Supervise, organize and review the work of lower level staff.

3 Train and evaluate staff. Interpret and apply pertinent Federal, State and local laws, codes and regulations including claims law and state worker's compensation law. Analyze claims made against the City and recommend methods of resolution. Negotiate effectively to settle claims. Participate in litigation strategy development. Maintain confidential records and files. Respond to requests and inquiries from the general public. Operate office equipment including computers and supporting word processing and spreadsheet applications. Communicate clearly and concisely, both orally and in writing. Establish and maintain effective working relationships with those contacted in the course of work. Maintain mental capacity which allows for effective interaction and communication with others. Maintain physical condition appropriate to the performance of assigned duties and responsibilities. Maintain effective audio-visual discrimination and perception needed for making observations, communicating with others, reading, writing and operating assigned equipment. Experience and Training Guidelines Any combination of experience and training that would likely provide the required knowledge and abilities is qualifying. A typical way to obtain the knowledge and abilities would be: Experience: Two years of increasingly responsible experience in processing and adjusting liability and worker's compensation claims. Training: Bachelors degree from an accredited college or university with major course work in public administration, business administration, risk management or a related field. WORKING CONDITIONS Environmental Conditions: Office and field environment; travel from site to site; exposure to inclement weather conditions and potentially irate citizens. Physical Conditions: Essential and marginal functions may require maintaining physical condition necessary

4 for walking or standing for prolonged periods of time; operating motorized equipment and vehicles.

5