Position Classification Description

Position Class Code / Title: A1100 / Claims Specialist
Recruitment Tier: Tier 1
FLSA: Exempt
Grade: 12

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.


Within the Division of the Controller, coordinates and administers non-litigated workers compensation, property, and casualty claims. Processes and documents claims and ensures compliance with relevant policies, procedures, regulations, and legislation. Serves 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. Evaluates and processes claims as assigned, including determination of liability, damage, and exposure.
  2. Manages third-party claims to include negotiations and settlement; escalate as needed.
  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. Provides support to internal and external customers. Serves as a primary point of contact and source of information for individuals involved in assigned claims.
  6. Researches and complies appropriate medical information and facts regarding claims. Represents the university at Workers' Compensation Administration mediation and formal hearings; represents the University at trials and other mediations as requested.
  7. Coordinates and participates in strategic planning aimed at reducing the incidence of worker's compensation-related injuries on campus.
  8. Provides 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, return to work program, legislation, regulations, and processes, as well as on loss control procedures and related regulations. Designs and provides training and orientation programs to disseminate this information to the University community.
  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. Develops and presents 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 databases, performs integrated data analyses, and prepares reports.
  11. Performs miscellaneous job-related duties as assigned.

Minimum Job Requirements

  • High School Diploma or GED; at least 3 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.
  • 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: 05/02/2024