Claims Examiner

JOB SUMMARY

This position is located in the District of Columbia Office of Risk Management (ORM). The mission of the ORM is to reduce the probability, occurrence and cost of risk to the District of Columbia government through the provision of risk identification and
insurance analysis and support to District agencies, and by efficiently and fairly administering the District's public workers compensation and tort liability programs.

The Claims Examiner in this role is responsible for independently investigating, evaluating, and adjudicating tort liability and property damage claims within delegated authority. The position authorizes settlements and denials, pursues subrogation recoveries, and
coordinates with District agencies and other stakeholders to ensure timely, equitable, and legally compliant claims resolution while supporting the District's risk management objectives.

DUTIES AND RESPONSIBILITIES

The incumbent The Claims Examiner administers complex tort liability and property damage claims by conducting investigations, evaluating liability, determining damages, authorizing settlements and denials within delegated authority, and ensuring compliance with applicable District laws, regulations, and the Office of Risk Management policies. Conducts comprehensive investigations by reviewing police reports, contracts, photographs, public records, medical documentation, witness statements, and other relevant evidence; interviewing employees, complainants, attorneys, witnesses, and other parties; and preparing investigative reports. Performs on-site inspections and field investigations, if practical, involving agency vehicles, District-owned property, accident scenes, and other locations.

The Claims Examiner analyzes claims information by conducting legal and factual research, establishing and adjusting claim reserves, evaluating damages, monitoring claim activity, and maintaining accurate claims data. Coordinates claims activities with the Office of the Attorney General, District agencies, insurance carriers, medical providers, investigators, and other stakeholders. Provides technical guidance and customer service to District agencies regarding claims reporting requirements, liability issues, documentation standards, and claims handling procedures, while maintaining claims tracking systems and official records, identifying emerging trends, and recommending process improvements.

QUALIFICATIONS AND EDUCATION

Specialized Experience: Experience that equipped the applicant with the particular knowledge, skills and abilities to perform successfully the duties of the position and is typically in or related to the work of the position to be filled. To be creditable, at least one (1) year of specialized experience must have been equivalent to at least the next lower grade level in the normal line of progression.

LICENSES AND CERTIFICATION

None

WORKING CONDITIONS/ENVIRONMENT

Work is typically performed in an office setting.

OTHER SIGNIFICANT FACTS

Tour of Duty: 8:30 AM 5:00 PM; Monday - Friday

Pay Plan, Series, Grade: CS-0998-12

Promotional Potential: No known promotion potential.

Duration of Appointment: Career Service Term Appointment Not-To-Exceed (NTE) 13 months.

Collective Bargaining Unit: This position is not in a collective bargaining unit.

Position Destination: This position has been deemed Security Sensitive under the guidelines of the DC Personnel Manual. Incumbents of this position are subject to enhanced suitability screening pursuant to Chapter 4 of DC personnel regulations. Accordingly, incumbents must successfully pass a criminal background and consumer credit check as a condition of employment and will be subject to periodic criminal background checks for the duration of their tenure.

Residency Preference: When claiming residency preference, you are required, and must agree in writing, to maintain bona fide District residency for a period of seven (7) consecutive years from the effective date of employment. You will be required to present documents (proofs) to show District residency and failure to maintain bona-fide District residency for the seven-year (7-year) period will result in forfeiture of employment.

EEOC Statement: The District of Columbia Government does not discriminate or retaliate in employment on the basis of race, color, religion, sex, pregnancy, gender identity and expression, national origin, family responsibilities, political affiliation, sexual orientation, marital status, homeless status, disability, genetic information, age, membership in an employee organization, participation in a legally protected activity, parental status, matriculation, personal appearance, credit information, status as a victim or family member of a victim of domestic violence, sexual offense, or stalking, military service, or other non-merit factor.