Claims Adjuster I( repost 4-8-26)

This is entrance level work, which involves the investigation of claims for loss or damages stemming from injuries obtained by workers.

An employee in this class 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. The employee receives supervision from a higher-level officer and is expected to use good judgment in carrying out assignments.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 claimants in obtaining reports in support of claims, and maintains constant contact with medical facilities in order to complete case files.
• Calculates and prepares payments due claimants; prepares and submits orders and vouchers for payments of claims to the supervisor for signature.
• Forwards to the Government Insurance Fund, orders and vouchers for payment, and distributes checks when payments are made.
• Maintains statistical records for use in monthly and annual reports.
• Performs other related work as assigned.

An Associates of Arts degree from an accredited college or university and two (2) years of work experience in a closely related field.

OR

Graduation from high school or its equivalent and four (4) years progressively responsible experience in a closely related field.

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 claims.
• Ability to deal with the public effectively.

FACTOR 2 – SUPERVISORY CONTROLS

Work is closely reviewed for accuracy, adequacy and adherence to instruction and established procedures.

FACTOR 3 – GUIDELINES

Guidelines consist of agency manuals of instructions and operations, local and national guidelines and codes as they relate to Worker's Compensation.

FACTOR 4 – COMPLEXITY

The 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 CONTACTS

Contacts are made with the general public, other government agencies, contractors, employers and co-workers.

FACTOR 7 – PURPOSE OF CONTACTS

Contacts are made to obtain, verify, transmit or exchange factual information as they relate to clients.

FACTOR 8 – PHYSICAL DEMANDS

Work 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 ENVIRONMENT

Work is performed primarily in an office setting.