Claims Adjuster II

JOB
Under supervision from the section head, an employee in this class investigates claims for loss or damage stemming from injuries obtained by workers; interviews or corresponds with claimants in order to determine the extent of damage and prepares reports of findings and submits such for the settlement of claims. An employee in this position provides support to the program under guidance and supervision of the head of the unit. General supervision is received through conferences and review of work for compliance with departmental rules and regulations.

EXAMPLE OF DUTIES
DUTIES (NOT ALL INCLUSIVE) Provides information to the public, particularly employees and employers on the provision of the Worker's Compensation Chapter relative to insurance coverage, benefits and the requirements for the filing of claims. Receives and examines reports of injury. If damages are evident, invites prospective claimants in for interviews. Assists claimants in preparation of claims. Assists injured workers in obtaining medical and in obtaining medical reports for completion of their claims prior to settlement. Calculates and prepares payments due claimants on claims; prepares and submits orders and voucher for payment of claims for signature by the administrator. Forwards to the Government Insurance Fund, orders and vouchers for payment, and distributes checks when payments are made. Maintains files and statistical records for use in monthly and annual reports. Performs other related work as assigned.

SUPPLEMENTAL INFORMATION
FACTOR 1 – KNOWLEDGE REQUIRED BY THE POSITION Knowledge of the pertinent laws, regulations, and agency practices; and extensive ability to deal with persons on a face-to-face basis. Ability to type accurately. Ability to calculate payments of claims accurately. Ability to interview claimants and employers relative to claims and filing. Ability to assist in analyzing reports and claims. Ability to follow practices and procedures of other agencies relative to vouchers and payments of claimants. Ability to deal with the public effectively.FACTOR 2 – SUPERVISORY CONTROLS Work is closely reviewed for accuracy, adequacy and adherence to instruction and establish procedures.FACTOR 3 – GUIDELINESGuidelines consist of agency manuals of instructions and operations, local and national guidelines and codes as they relate to Worker's Compensation.FACTOR 4 – COMPLEXITYThe employee uses good judgment in verifying claims, and maintains accurate files to substantiate all actions taken on the claimant.FACTOR 5 – SCOPE AND EFFECT The purpose of this position is to investigate, and examine reports of employee's claims, and to determine if all claims meet the provision of the Worker's Compensation regulation; then determine what compensation must be administered to the client.FACTOR 6 – PERSONAL CONTACTSContacts are made with the general public, other government agencies, contractors, employers and co-workers.FACTOR 7 – PURPOSE OF CONTACTSContacts are made to obtain, verify, transmit or exchange factual information as they relate to clients.FACTOR 8 – PHYSICAL DEMANDSWork is mostly sedentary, but may require some walking and driving to activity site, and to agency to gather information to assist in the determination of compensation.FACTOR 9 – WORK ENVIRONMENTWork is performed primarily in an office setting.