Adjuster

Claims Investigator

Investigate, negotiate, adjust and settle a variety of claims filed against the City including workers compensation claims and/or general liability 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 Descriptions are not intended to reflect all duties performed within the job.

Essential and Supplemental Functions

ESSENTIAL FUNCTIONS: 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.

1. Investigate workers compensation or general liability claims filed against the City for causation and compensability; determine liability and benefits as appropriate under applicable laws and policies.
2. Contact claimants and obtain information regarding alleged damages; explain legal requirements for successfully maintaining a claim.
3. Perform field investigations to determine exact facts and causes of loss; take statements or photos; draw diagrams.
4. Review all medical reports on treatment activities; audit and approve medical invoices for payment; deny payment as appropriate.
5. Coordinate with and assist other departments with insurance related questions pertaining to workers compensation or general liability.
6. Effect recovery of settlement in assigned areas of responsibility; pursue subrogation recovery as warranted.
7. Maintain records and develop reports concerning new or ongoing claims; prepare statistical reports as required.
8. Establish and maintain a variety of claim review files and medical payment records; close files on computer when claim is settled.

SUPPLEMENTAL FUNCTIONS:

1. Prepare claim review memos for presentation to claims review board as required.
2. Participate in professional group meetings; stay abreast of new trends and innovations in assigned areas of claims responsibility.
3. Perform related duties and responsibilities as required.

Minimum Education, Experience And Additional Requirements

Education and experience directly related to the minimum requirements below may be interchangeable on a year for year basis. Associate's degree from an accredited college or university in business, public administration, risk management or related field; and Two (2) years experience in claims administration. 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 6 months from date of hire. Possession of a valid New Mexico Adjusters License and become bonded within six (6) months from date of hire.

Working Conditions

Environmental: Office 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; may operate a motor vehicle; operate a computer.