Senior Workers' Adjuster

Overview

Investigate, negotiate, adjust and settle the most complex claims filed against the City including workers compensation 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 Description s are not intended to reflect all duties performed within the job.

Essential functions may include, but are not limited to the functions listed below. Must be able to perform the essential functions of the job with or without a reasonable accommodation.

• Negotiate, adjust and settle the most complex claims filed against the City including workers compensation claims.
• Participate in mediation, settlement conferences, arbitrations, health care provider hearings or other legal proceedings in an attempt to settle assigned cases; prepare cases for presentation to the Claims Review Board.
• Investigate workers compensation claims filed against the City for causation and compensability; assess loss; determine benefits as appropriate under applicable laws and policies.
• Interview claimants, City staff and witnesses; inspect accident sites, obtain pertinent documents; obtain written and recorded statements.
• Recommend settlement of assigned claims in accordance with applicable laws and policies; ensure claims are reported to appropriate agency.
• Assist in litigation proceedings; gather data, provide investigation results and prepare related documentation.
• Maintain records, document plans of action concerning new or ongoing claims; document all relevant information to provide a clear history of events and a proper audit trail; accurately report information within the established time frames and guidelines; prepare statistical reports and submit documentation to requesting agencies as required.
• Coordinate with and assist other departments with insurance related questions pertaining to workers compensation.
• Respond to questions and inquiries from the general public in a professional and courteous manner.
• Evaluate claims for potential third party or subrogation recovery.
• Worker's Compensation Division
  • Reviews workers' compensation claim documentation for compensability, causation and exposure in accordance with applicable laws, policies, and industry best practices.
  • Provide information and assistance to City personnel, injured employees, claims administrators, and medical and legal professionals; inform departments of an injured employee's permanent work restrictions; assist in the coordination of appropriate accommodations.
  • Coordinate health care and grant authorization for medical treatments; review medical reports for progress of treatment; ensure treatment and benefits related to the original on the job injury and are medically appropriate in accordance with the disability and medical guidelines.
  • Set, monitor and adjust reserves according to the worker's injury and industry standards; issue timely and accurate payment of statutory indemnity and medical benefits in accordance with workers' compensation statutes, rules and regulations and contractual agreements.
  • Compare and reconcile claim records with City payroll records; monitor injury time benefits according to City Personnel Rules and Regulations and resolve discrepancies.

SUPPLEMENTAL FUNCTIONS:

• Attend and participate in staff meetings and keep supervisor informed of status on all assigned cases and plan of action.
• Stay abreast of new trends, pending legislation, and case law related to workers' compensation.
• Perform related duties and responsibilities as required.

Education and experience directly related to the minimum requirements below may be interchangeable on a year for year basis.

Bachelor's degree from an accredited college or university in business administration, public administration, or risk management;
and

Four (4) years of claims experience.

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 six (6) months from date of hire.
• Possession of a valid New Mexico Adjuster License within six months from date of hire.

Environmental:
Office and field 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; operate a motor vehicle; operate a computer.