DEPENDING ON THE VOLUME OF APPLICATIONS RECEIVED, THIS POSITION MAY CLOSE PRIOR TO THE STATED DATE.
Under general supervision of the Risk Manager, performs professional work handling all worker’s compensation claims and/or investigating all liability claims against the City to determine liability/compensability for the injury and/or property damage and /or how to rectify the situation. Work involves the responsibility to independently handle all claims functions from case file setup to closure. An employee in this class must be licensed to independently authorize and sign state reports, setup and pay Workers Compensation benefits to employees, and coordinate the investigation of liability and/or Workers Compensation claims. Considerable knowledge of medical terminology and appropriate rates must be maintained as an employee in this position is responsible for reviewing medical charges, including physical therapy, prescriptions, or any other appropriate medical services. The work involves the exercise of considerable tact, discretion, effective communication, and thorough knowledge of claims proceedings as the employee may coordinate surveillance with investigators, work with attorneys regarding subrogation recoveries, coordinate with physicians, and be independently responsible for assigned cases. The work is reviewed through observation, conferences, and evaluation of results achieved. Performs related work as required. Position may require flexible work hours.
Individual(s) assigned to this classification must report to work per their assigned schedule.
SPECIFIC DUTIES AND RESPONSIBILITIES:
Sets up and runs daily Workers Compensation or General Liability checks; authorizes payments to employees.
Advises City personnel and affected individuals of City claims procedures in person and over the phone.
Coordinates all light duty employees’ schedules and assignments.
Maintains liaison with physicians, attorneys, investigators, City departments, employees, and the general public.
Reviews, verifies and authorizes claims documentation.
Maintains current working knowledge of Workers Compensation, county, state, and federal rules, regulations and laws to limit City liability when possible.
Prepares claims, medical authorizations to health care providers, rehabilitation counselors, claimants, and other interested parties.
May participate in defense preparation with City attorneys and various departments.
Establishes and maintains claims filing system, files and retrieves various records, files, forms, reports, and/or related department documents as directed.
Investigates scene of accidents, takes detailed statements from involved parties, photographs evidence to document investigation files, conducts other research as necessary.
Determines value of claim and coverage applicable; prepares a cost benefit analysis for settling claims.
Represents the City at claim settlements; negotiates settlement claims up to an authorized limit or makes recommendations for settlement to Risk Manager.
Attends safety meetings.
Bachelors Degree in Public/Business Administration, Insurance or related field and (3) three years professional experience in claims in area of assignment or insurance related settlement and investigative work; or an equivalent combination of related training and experience. Florida Independent All Lines Adjuster License or Florida Workers Compensation Adjuster License is required within six (6) months of hire or promotion. Must possess a valid Florida driver’s license, or valid State driver’s license and obtain a Florida driver’s license within thirty (30) days of hire or promotion.
ADDITIONAL MINIMUM QUALIFICATIONS REQUIRED: KNOWLEDGE, SKILLS, AND ABILITIES:
Thorough knowledge of Florida Workers Compensation and/or General Liability claims rules, regulations and procedures.
Knowledge of General Liability claims administration and the techniques of investigation, adjustment, negotiation and settlement.
Knowledge of medical or other technical terminology that may be related to claims handling.
Skilled in research techniques.
Some knowledge of surveillance techniques, rules and procedures.
Skilled in the use of modern automated office equipment including personal computers and related application software.
Ability to express ideas clearly and concisely, orally and in writing.
Ability to effectively explain technical claims problems or procedures in simple, non-technical language when necessary.
Ability to maintain effective relationships with employees, attorneys, physicians, investigators and other agencies or departments as required by the work.
MINIMUM STANDARDS REQUIRED:
Physical Requirements: Tasks are essentially sedentary, with some unassisted lifting, carrying, pushing and/or pulling of light weight objects up to 20 pounds. Tasks may require prolonged periods of visual concentration and keyboard work.
Data Conception: Requires the ability to compare and/or judge the readily observable, functional, structural or composite characteristics (whether similar or divergent from obvious standards) of documentation, accounting, and applications.
Interpersonal Communication: Requires the ability of speaking and/or signaling people to convey or exchange information. Includes giving and receiving instructions, assignments or directions.
Language Ability: Requires the ability to read a variety of materials relevant to municipal policy, procedure, and ordinance. Requires the ability to communicate with numerous individuals from a broad array of backgrounds.
Intelligence: Requires the ability to apply principles of rational systems; to solve practical problems and deal with a variety of concrete variables in situations where standardization exists.
Verbal Aptitude: Requires the ability to record and deliver information, to explain procedures, to issue and follow oral and written instructions. Must be able to communicate effectively and efficiently in Standard English.
Numerical Aptitude: Requires the ability to add, subtract, multiply, and divide; calculate decimals and percentages.
Form/Spatial Aptitude: Requires the ability to inspect items for proper length, width and shape and visually read various types of information.
Motor Coordination: Requires the ability coordinate hands and eyes in utilizing modern office equipment.
Manual Dexterity: Must have minimal levels of eye/hand/foot coordination.
Color Discrimination: Requires the ability to differentiate between colors and shades of color.
Interpersonal Temperament: Requires the ability to deal with people beyond giving and receiving instructions. Includes considerable personal contact, and potential confrontational situations.
Physical Communication: Requires the ability to talk and hear: (Talking: expressing or exchanging ideas by means of spoken words. Hearing: perceiving nature of sounds by ear.)
Environmental Requirements: Tasks are generally performed without exposure to adverse environmental conditions.
City of Cape Coral, FL - 22 months ago