Claims Analyst

PRIMARY FUNCTIONS

Supports the District’s self-insurance program through the timely and thorough processing of property, auto, workers compensation, and liability claims and related coordination with our third-party adjusters, peers, and legal counsel. Provides administrative support to the Risk Manager.

SUPERVISED BY

Risk Manager and/or their appointed designee(s).

CLASS CHARACTERISTICS

Employee performs a range of duties that require specific experience and technical knowledge of assigned areas of responsibility. Employees at this level are required to be fully trained in all regulations, laws, policies and procedures related to their job duties.

SUPERVISION RECEIVED AND EXERCISED

Receives direction from an assigned administrator. Methods of performing tasks are the responsibility of the employee and are to be performed within the established policies or as prescribed by rules and regulations to achieve the expected outcomes. Work is reviewed periodically to ensure compliance to standards.

ESSENTIAL FUNCTIONS

Claims Processing

1. Contacts staff for relevant information concerning claims and complete loss investigations as needed. Provides pro-active communication and expectations to staff members impacted by a loss.
2. Maintains accurate and comprehensive claim documentation. Issues timely claim payments.
3. Accurately identifies claim triggers that warrant timely referrals to a third-party adjuster or legal counsel for ongoing claims management.
4. Processes, analyzes, and recommends claim settlements in assigned area(s) of responsibility at established dollar limits. Resolves claims in an expeditious manner.
5. Compiles, analyzes, evaluates, and collects loss information and statistics for various assigned District programs and reports.
6. Coordinates and promotes light duty opportunities for injured workers within the scope of union contracts, District policies, and workers’ compensation statutes.
7. Works directly with injured worker, physician, and management to return injured workers to temporary modified positions when appropriate.
8. Ensures maximum program reimbursement for Employer-At Injury Program.
9. Assists the District in proper administration of the workers’ compensation re-employment and re-installation regulations for injured workers who qualify.
10. Develops and provides training to District staff. Assists District staff in designing and implementing loss control measures.
11. Provides appropriate information to a variety of organizations and individuals.
12. Serves as a resource and liaison by coordinating information between external agencies, internal customers and plaintiffs.
13. Performs related duties consistent with job description and assignment.

 

Safety & Risk Management Services Office Support

1. Participates in District emergency response and fulfill duties as assigned in the Emergency Operations Center (EOC).
2. Provides excellent customer service for Safety & Risk Management Services (SRMS). 
3. Reviews field trip requests for adherence to District protocols and involves the Risk Manager when exceptions are identified. Maintains a complete record of trips.
4. Processes certificate of insurance requests.
5. Performs related duties consistent with job description and assignment.

 

MINIMUM QUALIFICATIONS

Knowledge of

1. Principles and practices of insurance and claims administration.
2. Work organization and research techniques sufficient to collect, analyze and interpret data.
3. Basic office practices, including organization, data entry, record keeping, computer equipment, and computer software applications including claims processing techniques.
4. Principles and procedures of record keeping and reporting.
5. Problem solving and analysis of data.
6. Legal and medical terminology related to claims.
7. Principles and practices of safety, loss control, and claims administration.

Ability to

1. Complete timely and thorough claim investigations.
2. Maintain accurate and complete records.
3. Compile and analyze data.
4. Prepare complex technical reports and correspondence.
5. Create and maintain a variety of ledgers, logs, records, and reports.
6. Work independently with little supervision.
7. Work effectively in a team environment.
8. Maintain the highest level of confidentiality in all matters.
9. Type at a speed necessary for successful job performance.
10. Exercise diplomacy and tact when dealing with others.
11. Communicate clearly and concisely, both orally and in writing.
12. Establish and maintain cooperative-working relationships with staff and the public.
13. Provide excellent customer service.
14. Prioritize and multi-task effectively in an environment with frequent interruptions and competing demands.
15. Independently plan and effectively fulfill responsibilities of assigned area of work.

EXPERIENCE AND TRAINING

Any combination of experience and training that would provide the required knowledge and abilities is appropriate. A representative way to obtain the required knowledge and abilities would be:

Experience

Two (2) years of claims experience.

Education / Training

Possession of an Associate in Claims (AIC) designation and/or willingness to work toward earning this credential.

PREFERRED QUALIFICATIONS

1. Experience with workers’ compensation, property, auto and/or liability claims.
2. Proficiency and fluency with Spanish language (read, write, listen, and speak).

Work Environment

Climate controlled office setting with possible exposure to low to high noise intensity levels. High level of contact with district personnel, and moderate contact with outside agencies/community.

Physical Requirements

Frequent reaching, handling, fingering, talking and hearing. Mobility to work in a typical office setting and use standard office equipment, stamina to remain seated and maintain concentration for an extended period. Hearing and speech to communicate in person or over the telephone. Vision to read printed materials, computer screens and/or other monitoring devices.

Strength: Sedentary/Medium – Exert force to 15 pounds occasionally or a negligible amount of force frequently to lift, carry, push, pull or move objects.

TERM OF EMPLOYMENT

12months

SALARY LEVEL

Placement upon the current Salem-Keizer Public Schools classified employee salary schedule. Grade 21.

EVALUATION

The performance of this position will be evaluated according to the District’s process for the evaluation of classified personnel.