Senior Tort Adjuster

Position Summary

Investigate, negotiate, adjust and settle the most complex claims filed against the City including workers compensation 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.

• Negotiate, adjust and settle the most complex claims filed against the City including workers compensation claims.
• Participate in mediation, settlement conferences, arbitrations, health care provider hearings or other legal proceedings in an attempt to settle assigned cases; prepare cases for presentation to the Claims Review Board.
• Investigate workers compensation claims filed against the City for causation and compensability; assess loss; determine benefits as appropriate under applicable laws and policies.
• Interview claimants, City staff and witnesses; inspect accident sites, obtain pertinent documents; obtain written and recorded statements.
• Recommend settlement of assigned claims in accordance with applicable laws and policies; ensure claims are reported to appropriate agency.
• Assist in litigation proceedings; gather data, provide investigation results and prepare related documentation.
• Maintain records, document plans of action concerning new or ongoing claims; document all relevant information to provide a clear history of events and a proper audit trail; accurately report information within the established time frames and guidelines; prepare statistical reports and submit documentation to requesting agencies as required.
• Coordinate with and assist other departments with insurance related questions pertaining to workers compensation.
• Respond to questions and inquiries from the general public in a professional and courteous manner.
• Evaluate claims for potential third party or subrogation recovery.

• Reviews workers' compensation claim documentation for compensability, causation and exposure in accordance with applicable laws, policies, and industry best practices.
• Provide information and assistance to City personnel, injured employees, claims administrators, and medical and legal professionals; inform departments of an injured employee's permanent work restrictions; assist in the coordination of appropriate accommodations.
• Coordinate health care and grant authorization for medical treatments; review medical reports for progress of treatment; ensure treatment and benefits related to the original on the job injury and are medically appropriate in accordance with the disability and medical guidelines.
• Set, monitor and adjust reserves according to the worker's injury and industry standards; issue timely and accurate payment of statutory indemnity and medical benefits in accordance with workers' compensation statutes, rules and regulations and contractual agreements.
• Compare and reconcile claim records with City payroll records; monitor injury time benefits according to City Personnel Rules and Regulations and resolve discrepancies.

SUPPLEMENTAL FUNCTIONS:

• Attend and participate in staff meetings and keep supervisor informed of status on all assigned cases and plan of action.
• Stay abreast of new trends, pending legislation, and case law related to workers' compensation.
• 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.

Bachelor's degree from an accredited college or university in business administration, public administration, or risk management; and

Four (4) years of claims experience.

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 six (6) months from date of hire.

Possession of a valid New Mexico Adjuster License within six months from date of hire.

Working Conditions

Environmental:
Office and field 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; operate a motor vehicle; operate a computer.