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Position Classification Description

Position Class Code / Title: A0100 / Claim Specialist
Recruitment Tier: Tier 1
FLSA: Exempt
Grade: 11

This is a description of a Staff Position Classification. It is not an announcement of a position opening. To view descriptions of current openings, please go to UNMJobs and Search Postings to view positions that are currently accepting applications.

The following statements are intended to describe, in broad terms, the general functions and responsibility levels characteristic of positions assigned to this classification. They should not be viewed as an exhaustive list of the specific duties and prerequisites applicable to individual positions that have been so classified.

Summary

Under limited supervision, coordinate, administer, and oversee the University's workers compensation program and property and casualty claims. Process and document all workers compensation claims and property & casualty claims, ensuring compliance with relevant policies, procedures, and legislation. Serve as liaison with external agencies and regulatory bodies in the administration of claims and in the care and disposition of claimants.

Duties and Responsibilities

  1. Evaluate property and casualty claims to determine liability, damage and exposure.
  2. Handle third party claims to include negotiations and settlement.
  3. Reviews and evaluates all work-related accident reports for completeness and clarity of data; analyzes data, as needed, to ensure compliance with policy and regulatory requirements.
  4. Determines appropriateness and amount of worker's compensation claims; investigates individual claims for eligibility for workers' compensation benefits; ensures that all legal and procedural requirements are met for the processing of claims, in order to ensure proper and timely payment to employees and medical facilities.
  5. Provide authoritative advice and counsel campus-wide to University officials, administrators, faculty, and staff on the interpretation and application of worker's compensation and property & casualty policies, legislation, regulations, and processes, as well as on loss control procedures and related regulations; design and implement training and orientation programs to disseminate this information to the University community.
  6. Coordinates and participates in strategic planning aimed at reducing the incidence of worker's compensation-related injuries on campus.
  7. Assembles appropriate medical information and facts regarding claims for cases pending litigation; represents the university at Workers' Compensation Administration mediation and formal hearings; represents the University at trials and other mediations as requested.
  8. Communicates and interacts with medical professionals, support agencies and others to monitor and assess the progress of rehabilitation efforts, and to facilitate either return to work or, depending upon medical status of the claimant, placement into appropriate alternative positions within or outside the University, ensuring compliance with all appropriate regulations and guidelines.
  9. Prepares all necessary forms, records and documentation, to include statistical analyses and reports, for all claims assigned, as required by various regulatory agencies.
  10. Makes strategic recommendations for reducing the frequency and severity of losses through the use of a workers' compensation database and/or other claims data reports; designs and develops data bases, performs integrated data analyses, and prepares reports.
  11. Processes assigned property and casualty claims and performs other job-related duties as assigned.
  12. Performs miscellaneous job-related duties as assigned.

Minimum Job Requirements

  • Successful completion of at least 60 college-level credit hours; at least 2 years of directly related experience in claims adjusting, investigations, litigation and/or risk management.
  • Completed degree(s) from an accredited institution that are above the minimum education requirement may be substituted for experience on a year for year basis.

Knowledge, Skills and Abilities Required

  • Strong interpersonal and communication skills and the ability to work effectively with a wide range of constituencies in a diverse community.
  • Ability to use independent judgement and make appropriate insurance claims adjustment decisions and determinations.
  • Ability to document work in progress.
  • Conflict resolution and/or mediation skills.
  • Knowledge of process requirements of administrative hearings and litigation.
  • Knowledge of data management systems and processes.
  • Knowledge of workers' compensation, property and liability claims legislation, regulations, policies, processes, and procedures.
  • Knowledge and understanding of the principle and procedures for the investigation and processing of casualty/liability/workers compensation insurance claims.
  • Ability to communicate effectively, both orally and in writing.

Conditions of Employment

  • Valid New Mexico Driver's License.

Working Conditions and Physical Effort

  • No or very limited physical effort required. Ability to lift a maximum of 20 lbs (books, manuals, boxes).
  • Frequent travel.
  • Occasional work in adverse weather conditions and extreme temperatures.
  • Occasionally must deal with hostile individuals in emotionally charged settings.
  • No or very limited exposure to physical risk.
  • Work is normally performed in a typical interior/office work environment.

The University of New Mexico provides all training required by OSHA to ensure employee safety.

Revised Date: 03/20/2017