Claims Adjuster

Job Description

The New Mexico Self-Insurers Fund is seeking an experienced Claims Adjuster to perform a variety of advanced level, technical and administrative duties as needed to expedite the review, processing, investigation, and disposition of various claims filed against Fund policies and programs, including automobile, automobile physical damage, property, workers’ compensation, general liability, civil rights, and law enforcement claims.

REPORTING STRUCTURE

Works under direct supervision of Risk Services Director.

RESPONSIBILITIES

Receives claims from various insureds; determines coverage eligibility; evaluates negligence, liability, and applicable coverage for losses; based upon investigation and analysis, makes recommendation to deny, defend, negotiate, or pay claims; offers and/or negotiates settlements to assure appropriate compensation for loss.

Performs cost control actions; sets reserves for various claims to assure adequate availability of financial resources; manages reserve pools according to established guidelines and procedures; coordinates with reserve adjusters quarterly to determine need to increase or decrease reserves.

Coordinates and supervises contract work of independent adjusters for claims investigation; monitors case progress and activities to assure quality and accuracy of results; supervises settlement actions with structured settlement companies; may conduct periodic site evaluations and reviews to verify and validate results submitted by independent adjusters.

Follows established guidelines related to settlement limits; initiates advanced review processes when limits are exceeded; utilizes various resolution options or processes including settlement offers, mediation, arbitration, or litigation as needed.

Conducts follow-up on subrogation claims; manages and monitors professional services provided in conjunction with settlement agreements including medical care, nursing care, physical therapy, legal consultation, etc.; assures delivery of approved care and appropriate payment of fees.

Participates as member of claims committee; makes presentations to risk services director, executive director, and trustees as needed to provide case detail, history, and investigative results for the settlement of large claims.

Performs other duties as assigned.

QUALIFICATION CONSIDERATIONS

Bachelor’s Degree preferred.

At least 15 years related experience preferred.

Active, good-standing Independent/Staff Adjuster License 18-40.

Knowledge of general liability, civil rights, law enforcement, workers’ compensation, life, medical claims adjudication policies, procedures, and processes where necessary; legal, medical and insurance industry technology; organizational communications; interpersonal communication skills; negotiation techniques; technical writing; principles of organizational design, supervision, and motivation.

Ability to draft technical reports; analyze a variety of claims issues and make recommendations; communicate effectively in writing and orally; establish and maintain effective working relationships with professionals, executives, department heads, co-workers, and the public; work independently.

COMPENSATION

Competitive pay, commensurate with qualifications and experience.

Compensation includes a comprehensive benefits package, including automatic 10 percent retirement contribution from employer, and up to additional 8 percent retirement fund matching contribution.

WORK LOCATION

Primary work location is at the Fund's Albuquerque or Santa Fe offices, with option to work remotely one day per week, job duties allowing.Company Description

The New Mexico Self-Insurers’ Fund provides workers’ compensation, general liability, and property insurance for municipalities and other political subdivisions.