Claims Adjuster

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Job description

JOB DESCRIPTION
Claims Consultant

Purpose Statement

The job of Claims Consultant is done for the purpose/s of evaluating, negotiating, and resolving property and liability claims; and serving as a resource to others.

This job reports to either Deputy Executive Director, Director of Claims and Litigation, or Manager of Claims and Legal Affairs as designated by management.

Essential Functions

· Administers and resolves complex property and liability claim files (e.g. confirming coverage, setting proper reserves, completing field investigations, determining eligibility, attending mediation and arbitration, negotiating settlements with claimants, authorizing payments within prescribed authority, etc.) for the purpose of ensuring quality claim handling and service to member districts within policies, procedures and budgets.

· Authorizes purchases of $500 or less and payment of claims for the purpose of ensuring expenses are within defined budget limits and/or fiscal practices are followed.

· Collaborates with other Teams for the purpose of addressing prevention and training issues.

· Communicates with Directors, related departments, member district personnel, experts, claimants, attorneys and other outside organizations for the purpose of coordinating investigations and activities, responding to inquiries, exchanging information and resolving claims and lawsuits.

· Develops and provides claims-based training to member districts in School Board meetings or regional training sessions for the purpose of educating the member districts on issues of coverage, liability and adjustment procedures.

· Embodies the principles and practices needed to meet the WSRMP's Mission and Targeted Strategies and commitment to Diversity, Equity and Inclusivity.

· Identifies and reports by Captioned Report catastrophe-level claims to management for transmittal to the Board and/or reinsures for the purpose of procuring settlement authority.

· Maintains a variety of manual and electronic documents, files and records (e.g. claim file, litigation file, claim diary, electronic claim notes, etc.) for the purpose of documenting claim activities in accordance with WSRMP guidelines.

· Manages complex litigated claim files including monitoring discovery, directing activities of defense counsel, attending mock trials, mediations, legal motion and trials for the purpose of ensuring appropriate litigation management and legal cost management and setting proper reserves.

· Oversees claim file reserves (e.g. initial reserves, reserve adjustments based upon material changes in liability or damages, formal reserve reviews, limiting reserve redundancy, etc.) for the purpose of setting realistic funding levels within budget and in compliance with established regulations.

· Utilizes fleet vehicles for the purpose of performing the essential functions of the position.

Other Functions

· Assist other personnel as may be required for the purpose of ensuring an efficient and effective work environment.

Job Requirements: Minimum Qualifications

SKILLS are required to perform multiple, technical tasks with a potential need to upgrade skills in order to meet changing job conditions. Specific skill-based competencies required to satisfactorily perform the functions of the job include: See competencies under Abilities below.

KNOWLEDGE is required to perform basic math, including calculations using fractions, percent, and/or ratios; understand written procedures, write routine documents, and speak clearly; and solve practical problems. Specific knowledge-based competencies required to satisfactorily perform the functions of the job include: See competencies under Abilities below.

ABILITY is required to schedule activities and/or meetings; gather, collate, and/or classify data; and use job-related equipment. Flexibility is required to work with others in a variety of circumstances; work with data utilizing defined and similar processes; and operate equipment using standardized methods. Ability is also required to work with a wide diversity of individuals; work with a variety of data; and utilize a variety of job-related equipment. Problem solving is required to identify issues and create action plans. Problem solving with data may require independent interpretation; and problem solving with equipment is moderate. Specific ability-based competencies required to satisfactorily perform the functions of the job include:

JOB-SPECIFIC COMPETENCIES

ACCURACY AND ATTENTION TO DETAIL: Ensures work is thoughtfully completed, accurate, and error free to the highest degree possible.

CLAIMS MANAGEMENT: Administers the claims process from start to finish, utilizing case management best practices, risk analysis, critical thinking and interpersonal skills.

CUSTOMER FOCUS: Commits to clarifying and supporting internal and external customers' goals and strives to meet their expectations and requirements. Consistently acts with customers in mind. Holds self-accountable for providing high-quality, responsive and personable customer service.

FUNCTIONAL/TECHNICAL SUBJECT MATTER EXPERT: Possesses required functional/technical knowledge and skills to perform job responsibilities. Demonstrates active interest and ability to maintain level of knowledge and enhance and apply new functional skills.

Responsibility

Responsibilities include: working under limited supervision using standardized practices and/or methods; leading, guiding, and/or coordinating others; directing the use of budgeted funds within a work unit. Utilization of some resources from other work units is often required to perform the job's functions. There is a continual opportunity to impact the organization's services.

Work Environment

The usual and customary methods of performing the job's functions require the following physical demands: some lifting, carrying, pushing, and/or pulling, some climbing and balancing, frequent stooping, kneeling, crouching, and/or crawling and significant fine finger dexterity. Generally, the job requires 80% sitting, 10% walking, and 10% standing. The job is performed in a generally hazard free environment and in a clean atmosphere.

Experience: Job related experience with increasing levels of responsibility is required

Education: Targeted, job related education with study in job-related area

Equivalency:

Required Testing Certificates and Licenses

Claims Proficiency Test Valid Driver's License & Evidence of Insurability

Continuing Education / Training Clearances

Criminal Justice Fingerprint/Background Clearance

Job Type: Full-time

Pay: $78,488.00 - $102,983.00 per year

Benefits:

• Dental insurance
• Employee assistance program
• Health insurance
• Paid time off
• Parental leave
• Professional development assistance
• Retirement plan
• Vision insurance

Physical Setting:

• Office

Schedule:

• 8 hour shift
• Monday to Friday

COVID-19 considerations:
All employees are required to provide proof of vaccination and must wear mask during mask mandate.

Education:

• Bachelor's (Preferred)

Work Location: One location