Claims Administrator

6 months ago

Chicago, United States Metropolitan Water Reclamation District of Greater Chicago Full time

General Statement

Under direction, is responsible for the investigationof all claims on behalf of or against the District, oversees outside third-partyclaims administrator(s), directs the Return-to-Work Program, and maintains relatedprocedures and records.

Essential Job Functions

Essential job functions are fundamental, core functions common to positions in a classification. They are not intended to be an exhaustive list of all job duties for any one position in the class. Since class specifications are designed to be descriptive and not restrictive, incumbents may complete one or all of the job duties listed or tasks of similar kind not specifically listed here. Supervises the investigation of all non-litigated claims or potential actions on behalf of or against the District. Monitors the performance of outside third-party claims administrators for effectiveness and cost containment. Administers the Return-to-Work Program by providing direction and oversight to internal and external business units regarding accommodations that will facilitate returns to the workplace.  Supervises the work of employees assigned to assist in making investigations, securing information and assembling records, including the reporting, investigation and disposition of all Workers’ Compensation and other non-litigated claims. Attends and testifies at trials in courts and hearings before administrative bodies. Negotiates and recommends settlements of claims and makes preliminary approvals of payments of claims; prepares appropriate documentation. Organizes and oversees claims records and information; catalogs Illinois Workers’ Compensation Commission briefs. Develops procedures for business unit claims reporting and handling, ensuring timely entry and updating of non-Workers’ Compensation claims (e.g., automobile liability, general liability, etc.) into the Risk Management Information System (RIMS). Administers the self-insured insurance program on behalf of the District.  Engages in public contact to investigate and resolve issues involving claims with the District. Assists attorneys in preparing cases for trial at the Illinois Workers’ Compensation Commission, serving as a resource to the District’s Law Department in the claims and litigation process.  Stays up to date on changes within and related to the Illinois Workers’ Compensation Commission, pending regulations and case law related to workers’ compensation.

Other Job Functions

Develops and provides current and historical claims activities reports to inform management, identify trends and recommend appropriate cost containment techniques. Works with Safety Section staff to identify core causes of accidents in order to develop approaches designed to reduce their frequency and severity. Assists in the development of projections for claims cost and payment patterns for use in budget development and reporting.  Performs other duties as assigned.

Environmental Conditions

Typical office environment. May use standard office equipment andcomputer terminals. Field work is performed in a wastewater treatment plantwhich may include exposure to a variety of operating mechanical equipment, loudnoise and/or noxious odors. Dutiesinvolve operation of a motor vehicle.

Desirable Knowledge, Skills and Abilities

Considerable knowledge of the Illinois Workers’ Compensation Act and the Illinois Occupational Diseases Act. Considerable knowledge of the procedures of the Illinois Workers’ Compensation Commission.  Thorough knowledge of auto and general liability claims. Skill in reviewing technical reports and analyzing complex claims information. Skill in setting up and conducting complex meetings with possibly opposing parties. Skill in conducting and eliciting information through interviews. Ability to project future claims cost and payment patterns based on claims analysis. Ability to interpret the provisions of insurance policies.  Ability to communicate effectively, orally and in writing.

Minimum Qualification Requirements

Graduation from an accredited four-year college or university majoring in business administration or public administration and four years of experience in claims adjusting or claims examining, including two years in the area of Workers’ Compensation, and one year of experience in a supervisory capacity.

Substitution

Additional experience in claims adjusting or claims examining may be substituted for the required college education on a year-for-year basis.

Promotional Requirement

One year of service with the District as a Claims Examiner. Civil service status as a Claims Examiner.

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