Workers’ Compensation Claims Adjuster

SUMMARY

The Workers’ Compensation Claims Adjuster is responsible for handling workers’ compensation claims in concert with the Alaska Municipal League Joint Insurance Association’s (AMLJIA’s) goals and objectives. In addition, this position will provide technical expertise and direction to team members as needed.

NATURE OF THE ORGANIZATION
The Alaska Municipal League Joint Insurance Association (AMLJIA) is a not-for-profit municipal risk management pool, serving municipalities and school districts statewide.  AMLJIA participants must be members in good standing of the Alaska Municipal League (AML) in order to become a participant in the AMLJIA insurance and risk management programs.

Headquartered in Anchorage, with a branch office in Juneau, the AMLJIA is an operational division of the AML.  The Executive Director, who administers the programs, heads the organization and directly supervises the Finance and Claims Department. The Deputy Director directly supervises the Underwriter, Human Resources, and Risk Management departments.

The AML is a private, not-for-profit, non-partisan service organization.  The AML is a membership association of local governments in Alaska with an Executive Director that reports to a Board of Directors elected by the membership, and a budget coming primarily from member dues.

NATURE OF WORK

The Claims Adjuster is expected to perform duties and responsibilities associated with the handling of workers’ compensation claims as assigned by the Claims Manager.  These duties are to be performed well by the individual in this position under general supervision.  This position requires attention to detail to maintain a precise audit trail, for the protection and reliability of all internal and external information.

The Workers’ Compensation Claims Adjuster is a professional position supervised by the Claims Manager.

ESSENTIAL DUTIES AND RESPONSIBILITIES
Handles assigned caseload requiring solid understanding of claims handling.  Review and process claim files, complete thorough investigations, diary entries and reports as required in claim files.

Completes thorough investigation on claims assigned to this position to determine compensability and develop case strategy.

Evaluate the claims in litigation and claims before the Workers’ Compensation Board with direction from the Claims Manager.

Ensures compliance with Alaska Statutes regarding claims handling.

Reports potential problems or areas of concern to the Claims Manager regarding claims handling techniques or areas of concern with other departments.

Maintains contact with members regarding claims statutes and pool coverage.

Maintains contact with injured workers and members/employers.

Keeps the Claims Manager informed on status of claims.

Settlement authority as set by the Policies and Procedures.

Reports to Excess and Reinsurance in accordance with the Policies and Procedures with direction from the Claims Manager.

Adjusts reserves to ensure accurate financial exposure.

Maintains prescription, Medicare and EDI systems electronically.

Performs other duties as may be assigned.

QUALIFICATION REQUIREMENTS
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

EDUCATION and/or EXPERIENCE

A Bachelor’s degree in business administration, public administration, or a closely related field and three years of adjusting experience; or any equivalent combination of experience and training which provides the required knowledge, skills and abilities.

LANGUAGE SKILLS

·       Ability to read, analyze, and interpret general business periodicals, professional journals, technical procedures, contracts or governmental laws, regulations or ordinances.

·       Ability to write reports, business correspondence, and procedure manuals.

·       Ability to effectively present information and respond to questions from groups of managers, clients, customers, and the general public.

MATHEMATICAL SKILLS

·       Ability to add, subtract, multiply and divide all units of measure.

·       Ability to apply concepts such as fractions, percentages, ratios, and proportions to practical situations.

REASONING ABILITY

·       Ability to define problems, collect data, establish facts, and draw valid conclusions.

·       Ability to interpret an extensive variety of technical instructions in mathematical or diagram form and deal with abstract and concrete variables.

·       Ability to analyze complex proposals, contracts, risks and exposures.

OTHER SKILLS and ABILITIES

Working knowledge of the Workers’ Compensation Act, regulations and administrative procedures, court decisions and treaties relating to injury or disease.

Considerable knowledge of principles and practices of investigation, technical and medical terminology and vocational rehabilitation procedures and programs.

Working knowledge of legal research, writing skills, and hearing techniques.

Ability to function with a high degree of independence; interpret and apply workers’ compensation statutes and case laws.

Ability to analyze and evaluate technical medical and industrial information; convey information, orally and in writing, in simple, understandable and precise terms.

Some knowledge of basic insurance and pooling principles and practices, contract coverage, liability and adjustment procedures.

Computer literate; Windows, Microsoft Word and Excel experience required.

Must type a minimum of 45 wpm.

Must be able to work effectively with team members, staff, members, and the general public.  Must be able to work independently with general supervision; initiative and flexibility required.

CERTIFICATES AND LICENSES REQUIRED

Must possess an Alaska Adjusters’ License.

Must maintain the required number of Continuing Education Credits as required by law.

Possession of, or ability to obtain, an appropriate, valid Alaska driver’s license.

PHYSICAL DEMANDS

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

While performing the duties of this job, the employee is regularly required to sit; use hands to finger, handle, or feel objects, tools, or controls; and talks or hears. The employee is occasionally required to stand; walk; reach with hands and arms; climb or balance; and stoop, kneel, crouch, or crawl.

The employee must regularly lift and/or move up to 10 pounds, frequently lift and/or move up to 15 pounds, and occasionally lift and/or move up to 25 pounds. Specific vision abilities required by this job include close vision.

WORK ENVIRONMENT

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

The noise level in the work environment is usually quiet.

This job description is not an employment contract, implied or otherwise.  The employment relationship remains “At-Will.”  The AMLJIA reserves the right to modify, interpret, or apply this job description in any way the company desires in order to obtain business goals and objectives.  This job description in no way implies that these are the only duties, including essential duties, to be performed by the employee occupying this position.  The aforementioned job requirements are subject to change to reasonably accommodate qualified individuals with disabilities.