Workers Compensation Claims Adjuster

JSUMMARY OF FUNCTION

Investigates, evaluates, manages and concludes associated claims. Establishes claim reserves within approval levels; authorizes the processing of claim payments, maintains claim files, and assures for compliance with the district’s legal claim reporting obligations. Investigates, evaluates and concludes the recovery of expenses from subrogation, restitution or insurance policy remuneration.

ESSENTIAL JOB FUNCTIONS

· Provides litigation management on district litigated workers’ compensation claims

· Responsible for subrogation notification and recovery efforts related to workers’ compensation claims.

· Investigates, evaluates, directs, and concludes claims and related

activities as part of the daily operations of the Risk Management Office.

· Determines compensability or identifies questionable claims/injuries and manages appropriate responses.

· Counsels employees who suffer injuries; provide guidance on claim issues and other workers’ compensation benefits available to them.

· Evaluates, establishes, documents, and monitors claim reserves to adequate levels to control and pay the district’s liabilities on a timely basis.

· Coordinates, approves, recommends and directs the use of appropriate medical, legal or other professional, claim-related services.

· Authorizes, processes and documents timely payments of funds for claim-related expenses, recovery and reserves within authority levels.

· Makes appropriate and timely claim-related filings to the Colorado Division of Workers’ Compensation, and/or other parties as required.

· Authorizes, coordinates, manages, and appropriately documents claim files to include medical, indemnity, legal, subrogation and any other claim-related activities through risk management information system.

· Coordinates activities of claim review panels; recommends the level of appropriate settlement offers.

· Provides insurance policy related recommendations to district staff and management.

· Identifies unsafe employee work practices or loss related conditions or hazards to risk management and coordinates with supervisor and Safety Manager.

· Provide input and recommendations at depositions, litigation, and medical meetings as required.

· Notifies management of claim status as appropriate within financial authority levels.

OTHER DUTIES

· Performs related work and duties as assigned

KNOWLEDGE, ABILITIES, AND SKILLS

· Knowledge of commercial insurance claim adjustment procedures

· Proven ability to investigate insurance claims, establish facts and make sound recommendations

· Proven ability to communicate effectively

· Proven ability to work cooperatively with others

· Capacity to keep abreast and up-to-date with dynamic complex insurance and legal requirements through continuing education

· Familiar with certain regulatory requirements in their area of adjusting claims that may include Colorado Workers' Compensation benefits; the Colorado Governmental Immunity Act; EEOC, ADA, and Employment Law for public agencies preferred.

· Proven skills in critical decision making, working with complex issues, and in working with professionals in insurance industry, law and/or the medical field

· Ability to interpret and understand legal and contractual language and issues related to commercial insurance needs

· Good analytical skills, mathematical and bookkeeping skills; strong skills with data analysis, and the storage, retrieval and use of data base software; some knowledge of programming concepts

· Proven ability to establish and maintain effective working relationships with district personnel and management, medical, legal and/or other service providers, consultants, and with injured persons, their families and employees’ supervisors

· Good judgment skills; skills working with ambiguous information and skills as a self-starter and team player

· Aptitude in organizing, prioritizing and processing work flow under pressure

· Aptitude in recognition of sensitive information and maintaining confidentiality

QUALIFICATIONS

· Associates or Bachelor's degree and/or significant training or experience in related areas (1) general insurance claims investigating, adjusting, processing, etc. (2) insurance policy service, purchasing, renewal and (3) multi-line insurance coverage management, service, records management, and data reporting activities.

· Knowledge or certification in related claims or insurance management profession, such as Associate Risk Management (ARM), Commercial Insurance Service Representative (CISR), other insurance professional designations, or progress to obtain such certification preferred.

· Minimum of five years of progressively responsible experience as a commercial insurance service representative, underwriter or claims professional and at least five (5) years’ experience servicing the insurance requirements of a large employer within a centralized office.

· Possession of a valid Colorado driver's license and insurable.

ORGANIZATIONAL RELATIONSHIPS

Reports to and is evaluated by the Risk Manager

WORKING CONDITIONS

The work is primarily performed in a typical office environment with periods at worksites and accident scenes. Requires ability to visit locations away from the office, sometimes in poor weather conditions and difficult terrain. May require use of personal auto on district business, and may be asked to respond to emergency situations periodically during and after normal work hours

PHYSICAL DEMANDS

The work is primarily sedentary with periods of light to moderate physical activity, and is performed in offices, at other work sites, and accident scenes. Typical positions require workers to walk or stand for long periods; lift and carry up to 20 pounds; climb stairs, ladders or scaffolding; bend, kneel and crouch; reach, hold, grasp and turn objects; and use fingers to operate computer or typewriter keyboards. The work requires the ability to speak normally, to use normal or aided vision and hearing, and to detect odors.

FLSA STATUS

Exempt

WORK YEAR

260 Days

Job Type: Full-time

Pay: $53,381.00 - $77,766.00 per year

Benefits:

• 401(k)
• Dental insurance
• Flexible spending account
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Schedule:

• 8 hour shift
• Monday to Friday

Travel requirement:

• No travel

Work setting:

• In-person
• Office

Work Location: In person