- Position Summary
Investigate, negotiate, adjust and settle a variety of claims filed against the City including workers compensation claims and/or general liability claims; apply knowledge of applicable laws and policies to determine disposition of claims and perform a variety of technical tasks relative to assigned areas of responsibility.
Job descriptions are intended to present a general list of tasks/duties performed by employees within this job classification. Job Descriptions are not intended to reflect all duties performed within the job.- Essential and Supplemental Functions
ESSENTIAL FUNCTIONS: Essentialfunctions may include, but are not limited to the functions listed below. Mustbe able to perform the essential functions of the job with or without areasonable accommodation.
- Investigate workers compensation or general liability claims filed against the City for causation and compensability; determine liability and benefits as appropriate under applicable laws and policies.
- Contact claimants and obtain information regarding alleged damages; explain legal requirements for successfully maintaining a claim.
- Perform field investigations to determine exact facts and causes of loss; take statements or photos; draw diagrams.
- Review all medical reports on treatment activities; audit and approve medical invoices for payment; deny payment as appropriate.
- Coordinate with and assist other departments with insurance related questions pertaining to workers compensation or general liability.
- Effect recovery of settlement in assigned areas of responsibility; pursue subrogation recovery as warranted.
- Maintain records and develop reports concerning new or ongoing claims; prepare statistical reports as required.
- Establish and maintain a variety of claim review files and medical payment records; close files on computer when claim is settled.
- Prepare claim review memos for presentation to claims review board as required.
- Participate in professional group meetings; stay abreast of new trends and innovations in assigned areas of claims responsibility.
- Perform related duties and responsibilities as required.
- Minimum Education, Experience And Additional Requirements
Education and experience directly related to the minimum requirements below may be interchangeable on a year for year basis.
Associate's degree from an accredited college or university in business, public administration, risk management or related field; and
Two (2) years experience in claims administration.
ADDITIONAL REQUIREMENTS:
Possession of a valid New Mexico Driver's License, or the ability to obtain by date of hire.
Possession of a City Operator's Permit (COP) within 6 months from date of hire.
Possession of a valid New Mexico Adjusters License and become bonded within six (6) months from date of hire.- Working Conditions
Environmental:
Office environment; some travel from site to site; exposure to computer screens.
Physical:
Essential and supplemental functions may require maintaining physical condition necessary for walking, standing and sitting for prolonged periods of time; may operate a motor vehicle; operate a computer.