Position Classification Description

Position Class Code / Title: A4100 / Claims Specialist,Sr
Recruitment Tier: Tier 1
FLSA: Exempt
Grade: 14

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 and under minimal supervision, coordinates, administers, and oversees the University's workers compensation program, property, and casualty claims, and return to work program. Processes and documents workers compensation claims and property and casualty claims. 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, with particular emphasis on litigated claims.

Duties and Responsibilities

  1. Manages, evaluates and/or processes claim files, including investigation, liability determination, coverage confirmation, and resolution. Ensures all legal, regulatory, and procedural requirements are met.
  2. Manages all litigious claims cases. Represents the University at Workers' Compensation administration mediations, formal hearings, settlement conferences, and trials.
  3. Oversees claims management information systems. Organizes and retains relevant claims data, files, and documentation.
  4. Manages, and coordinates the University's return to work program. Collaborates with human resources, management, and internal and external stakeholders to facilitate mutually beneficial return-to-work strategies.
  5. 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.
  6. Provides support to internal and external customers. Serves as a primary point of contact and source of information for individuals involved in assigned claims.
  7. 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.
  8. Manages and oversees the review and evaluation of work related accident reports for completeness and clarity of data; analyzes data, as needed, to ensure compliance with policy and regulatory requirements.
  9. 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.
  10. Investigates claims, obtains appropriate data, and assembles appropriate information and facts regarding claims, including scene investigations, interviewing pertinent parties, and developing case summaries and timelines.
  11. Prepares all necessary forms, records and documentation, to include statistical analyses and reports, for all claims assigned, as required by various regulatory agencies.
  12. Performs miscellaneous job-related duties as assigned.

Minimum Job Requirements

  • Bachelor's degree; at least 4 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 individuals and constituencies in a diverse community.
  • Ability to use independent judgement and make appropriate insurance claims adjustment decisions and determinations.
  • Skill in developing and implementing return-to-work, modified duty programs.
  • Ability to assess the relative terms and conditions of casualty and liability insurance policies.
  • Ability to use independent judgment and to manage and impart confidential information.
  • Investigative skills pertaining to medical/legal claims and litigation.
  • Conflict resolution and/or mediation skills.
  • 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.

Distinguishing Characteristics

    Position requires: a) Oversight of the University's Return to Work (RTW) program; b) Advanced problem resolution regarding litigated claims.

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: 05/17/2024