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NEW MEXICO STATE UNIVERSITY
HUMAN RESOURCES SERVICES

POSITION CLASSIFICATION DESCRIPTION


Position Classification Title: Claim Specialist
Position Classification Code: L1023
Job Family: Human Resources
Pay Level: 07
Exempt Status: Exempt
This description is intended to describe the general nature of the work being performed. It is not intended to be a complete list of specific duties of any particular position. Duties, responsibilities and bargaining unit eligibility may vary based on the specific tasks assigned to the position.
Purpose of Classification:
Under limited supervision, coordinate, administer, and oversee the University's workers compensation and/or risk management claim program. Processes and documents workers compensation claims and/or risk management claims, ensuring compliance with relevant policies, procedures, and legislation. Acts as the University's authority on workers compensation and/or risk management policies and legislative provisions. Investigates, and makes decisions regarding compensability and appropriateness of claims. Provides liaison with and advisement to external agencies and regulatory bodies in claims administration and in the care and disposition of claimants.
Standard Duties:
Evaluate all work-related accident reports for completeness and clarity of data; analyzes data to ensure compliance with policy and regulatory requirements. May evaluate property and casualty claims to determine liability, damage and exposure. Investigates claims for eligibility and determines appropriateness and amount of worker's compensation and or risk management claims. May process third party claims to include negotiations and settlement. Ensures that claims processing meets legal and procedural requirements resulting in proper and timely payment to employees and medical providers. Advises University staff on and interprets loss and worker's compensation and/or risk management policies, procedures, legislation, and regulations; designs and implements training and orientation programs for the university community. Coordinates and participates in strategic planning aimed at reducing the incidence of worker's compensation-related injuries. Prepares all necessary forms, records and documentation, to include statistical analyses and reports, for all claims assigned, as required by various regulatory agencies. Designs and develops databases, performs integrated data analyses, and prepares reports. Performs miscellaneous job-related duties as assigned.
Knowledge, Skills and Abilities:
Knowledge of process requirements of administrative hearings and litigation. Knowledge of data management systems and processes. Knowledge of property and liability claims legislation, regulations, policies, processes, and procedures. Knowledge of applicable legislation, standards, policies and procedures within specialty area. 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.
Strong interpersonal and communication skills and the ability to work effectively with a wide range of constituencies in a diverse community. Records maintenance skills. Skill in examining and re-engineering operations and procedures, formulating policy, and developing and implementing new strategies and procedures. Conflict resolution and/or mediation skills. Skill in conducting accident investigations. Skill in developing and implementing return-to-work, modified duty programs.
Ability to use independent judgment and to manage and impart confidential information. Ability to use independent judgment and make appropriate insurance claims adjustment decisions and determinations. Ability to document work in progress. Ability to provide legal depositions and testimony. Ability to communicate technical information to non-technical personnel. Ability to investigate and analyze claims information and to draw conclusions.
Minimum Qualifications:
   Education- Bachelor's degree in a related field.
   Experience- Three (3) years of experience related to the standard duties as outlined.
   Equivalency- None
   Certifications/License-
   Departmental Requirements-
   Special Requirements-