Job Description

Job Description

Job Title - Claims Adjuster

Location - San Antonio, Texas, 78212

Duration - 6+ months

Claims Adjuster with Workers Compensation and/or Liability Claims Experience with Adjuster License. Handled workers’ compensation, general liability, auto liability and/or pollution liability claims and, with respect to workers’ compensation claims knows the deadlines required with such claims from both the insurance carrier and employer’s standpoint.

• Outline Essential Functions / Job Duties: Adjuster will be responsible for investigating instances where either: an employee sustained a bodily injury in the course and scope of employment, a customer alleges they sustained property damage or bodily injury as a result of Client's actions, and/or SAWS assets were damaged by third parties, primarily construction contractors, to determine if the third party was negligent. If so, the adjuster will make a demand on the third party for full recovery of the damages.
• Investigates all relevant facts and evaluates findings to determine coverage, negligence, and liability issues for each claim submitted to Client.
• Establishes appropriate reserves based on the estimated probable cost of the claim with the proper file documentation to explain the rationale behind the computation.
• Issues payments in a timely manner to claimants and vendors in accordance with all regulatory standards.
• Negotiates claim settlements for monetary recoveries for damages to Client's assets.
• Documents claim file activities in accordance with established procedures.
• Prepares claims narrative report(s) for documentation purposes outlining the facts of the case, applying the applicable sections of the Texas Tort Claims Act and a recommendation on claim resolution.
• Communicates effectively, written and orally, with customers including, but not limited to claimants, witnesses, employees, attorneys, medical professionals, governmental entities, and contractors.
• Determines the value and extent of related damages and/or workers compensation injuries by verifying support documentation and reviewing medical bills.
• Performs other duties as assigned.

JOB SUMMARY

The Claims Adjuster is responsible for investigating, evaluating, reserving, negotiating, and settling property, casualty, or workers’ compensation claims in accordance with Best Practices and in compliance with all City, State, and Federal regulatory laws. This position promptly and equitably resolves claims to minimize Client's ’ liability and reduces overall claims costs.

ESSENTIAL FUNCTIONS:

• Investigates all relevant facts and evaluates findings to determine coverage, negligence, and liability issues for each claim submitted to Client.
• Establishes appropriate reserves based on the estimated probable cost of the claim with the proper file documentation to explain the rationale behind the computation.
• Issues payments in a timely manner to claimants and vendors in accordance with all regulatory standards.
• Negotiates claim settlements for monetary recoveries for damages to Client's assets.
• Documents claim file activities in accordance with established procedures.
• Prepares claims narrative report(s) for documentation purposes outlining the facts of the case, applying the applicable sections of the Texas Tort Claims Act and a recommendation on claim resolution.
• Communicates effectively, written and orally, with customers including, but not limited to claimants, witnesses, employees, attorneys, medical professionals, governmental entities, and contractors.
• Determines the value and extent of related damages and/or workers compensation injuries by verifying support documentation and reviewing medical bills.
• Performs other duties as assigned.

MINIMUM REQUIREMENTS:

• High School Diploma or GED.
• One year’s experience investigating, evaluating, reserving, negotiating, and settling claims. Experience should be in one or more of the following claims disciplines: workers’ compensation, casualty (auto & property), appraising, personal injury and/or subrogation.
• State of Texas Multi–Line Claims Adjusters License as required by TIC 4101 or the ability to acquire a license within six [6] months of hire.
• Valid Class "C" Texas Driver's License.

JOB DIMENSIONS

• Knowledge of general negligence principals and their application within governmental communities, in particular the Texas Tort Claims Act.
• Skill in using a computer and job related applications.
• Skill in using various Risk Management Information Systems to document claim activity and maintain claim diary systems.
• Ability to analyze a proof of loss and/or property appraisal to determine actual cash value owed to claimants.
• Ability to maintain and submit accurate records within the required time periods.
• Ability to estimate time and materials needed for projects.
• Ability to maintain confidential information.
• Ability to perform all the physical requirements of the position.
• Ability to communicate clearly and effectively, both verbally and in writing.
• Ability to establish and maintain effective working relationships with staff, management, property owners, vendors, and governmental agencies.

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