Risk Management Claims Manager

Position Summary & Duties Responsible
POSITION SUMMARY

This position is responsible for managing the County’s worker’s compensation and general liability claims program. This position works closely with other County Department representatives, and serves as liaison with Third Party Administrators, external agencies and regulatory bodies in the administration of claims and exercises direct supervision over assigned staff.

DUTIES AND RESPONSIBILITIES SUMMARY

Manage and supervise personnel responsible for the Claims Section of the Risk Management Department. Ensures the Claims Section appropriately obtains necessary documents and forms from claimants and/employees, as well as photos of damage when applicable for each claim. Ensures the Claims Section evaluates policy coverage, liability and damages for each claim and then exercises good judgment in reaching final disposition of claim by evaluating nature of loss, liability, damage, coverage provided and applicable limits. Ensures the Claims Section procures timely completion of appraisals from vendors in order to determine claim related damages.

Closely supervises the Claims Section’s role in examining property and casualty clams above deductible which are adjusted by third-party administrator. Ensures the Claims Section investigates questionable claims to determine whether to authorize payments based on third-party administrator’s adherence to the Coverage Agreement. Audit for potential overpayments, and other irregularities.

Responsible for the development of policy, procedures, and work-flow processes related to the administration of internal claims under deductible/self-insured retention as well the oversight of claims adjusted by third party administrator above the deductible/self-insured retention.

Responsible for content of the Risk Management Claims Manual. Ensures best practices confidentiality are in use.

Actively work towards resolution and timely closure of claims in accordance with standards set forth by the Risk Management Director.

Responsible for the pursuing and managing subrogation and recovery whenever possible and applicable.

Monitor claims administration and actions performed by third-party administrators and service providers to ensure action in the best interest of the County. Ensure contractors responding to claims are following contract requirements.

Work with third party administrator, County Legal, contracted counsel, and other County departments with the processing, handling, and defending of tort claims. Research & analyze evidence presented by departments for defending tort claims.

Participate in development and execution of RFB’s and RFP Evaluation Committees related to the services of auto collision repair, occupational medicine services, windshield replacement, building glass replacement, etc.

Analyze and interpret reports and data provided in order to make recommendations on the reduction of potential risks to which the County is exposed.

Participate in mediations, hearings, etc. at the Workers’ Compensation Administration or other court proceedings.

Plan and facilitate regular claim reviews with insurance providers and County departments.

Represent the department on committees, in training/learning events, and in meetings. Create and/or conduct presentations.

Serve as LCPR (Local Custodian of Public Records) for the department. Responsible for the archive and retention of claim records in accordance with State Statutes and I cooperation with the Count Records Management section.

Propose and monitor the budget associated with the Claims section, such as deductible expenses, premium expenses, subrogation revenue, etc.

Review quotes/estimates, purchase orders, invoices for deductible payments, and requests for reimbursements by third party administrator for accuracy and accompaniment of adequate support documentation to justify the payment.

Audit and scrutinize final invoicing by vendors and third party administrator to determine adherence to initial quotes/estimates and coverage agreement, respectively.

Conduct investigations of all aspects of reported claims including potential fraud.

Create and conduct presentations and trainings to be provided to other departments, County leaders, etc.

Ensure compliance with all federal, state and local laws related to claims administration.

Must be able to assist internal and external customers with problems or questions regarding claims by phone or through written correspondence while providing a high level of customer service.

*The above information on this job description has been designed to indicate the general nature and level of work performed by employees within this classification. It is not designed to contain or be interpreted as a comprehensive inventory of all duties and responsibilities required of all employees assigned to this job.

Minimum Qualifications

Bachelor’s Degree in Business, Paralegal Studies, Pre-law, or similar plus 8 (eight) years’ work experience adjusting worker’s compensation and/or property and casualty claims, OR any combination of education from an accredited college or university in a related field and/or direct experience in this occupation totaling 12 may substitute for the required education and experience. Related education and experience may be interchangeable on a year for year basis.

Must have knowledge of risk management principles, New Mexico Worker’s Compensation Law, insurance law and practices, multiple lines of insurance, medical terminology, occupational safety and health regulations and record keeping, torts, case law, and law enforcement in order to ensure compliance with proper administration of claims.

Proficiency in the use of Windows-based work processing and spreadsheets, as well as in the use of software utilized in the creation and verification of repair estimates and property appraisals.

Broad knowledge of office procedures and methods including records management.

Must be able to effectively provide professional presentations and training.

Able to critically review and understand auto repair estimates, property damage appraisals, and medical reports,

Must have the ability to instruct and train others in procedures and functions required.

Ability to communicate effectively in both and written English, to prepare accurate, concise, complete, and informative written materials, and to make effective presentations to small or large groups.

Ability to manage projects and personnel effectively and to work productively either independently of as a team member or team leader.

Ability to maintain objectivity and confidentiality in dealing with a variety of complex and potentially sensitive projects.

Excellent organizational skills and ability to handle effectively multiple concurrent assignments, and activities.

Must have the ability to work independently and with minimal guidance.

Supplemental Information
SCREENING AND COMPLIANCE

The offer of this Bernalillo County position requires compliance with the following:

Employee must successfully complete the Bernalillo County post-offer medical examination.

Employee must comply with the safety guidelines of the County.

WORKING CONDITIONS

Essential duties are performed indoors in a climate –controlled environment.

Primary work surfaces is even , dry, carpeted or tiled floor.

Works alone primarily, with or without directions. Work with a group at times and with a select team at times.

EQUIPMENT, TOOLS AND MATERIALS

Equipment used in performing duties includes: computer, camera, typewriter, recording equipment, telephone, calculator, facsimile machine, and photocopy machine.

Materials and products handled on performance of duties include: logs, spreadsheet, graphs, pie charts, writing utensils, safety manual, rules and regulations, and various office forms.