6E08

                                                                                                                              PAY RANGE: 21

CLAIMS ADJUSTER 3

 

GENERAL DEFINITION

 

            This is complex field investigative and claims adjusting work at the most senior performance level.  Employees in this class gather and analyze detailed information for the purpose of determining the City's liability in personal injury, property loss, damage, and related claims.  Effecting out-of-court settlements is significant to the work.  The class is distinguished from the next lower class by the greater complexity, higher exposure, larger dollar value and more detailed analysis and investigation of the claims assigned in the unit.  Immediately responding to and thoroughly investigating high exposure and complex claims related to catastrophic loss or damage and consulting with the Law Department are significant aspects of the work.  Work is performed under the general direction of a Claims Manager.

 

ALLOCATING FACTORS:   (The following conditions must be met for a position to be allocated to this class.)

 

•           Positions must handle the most complex claims cases in the unit with responsibility to independently authorize settlements with values up to $25,000.

•           Positions must handle suspect claims requiring fraud investigation.

•           Positions must be located in the Risk Management Division of the Office of the Director of Finance.  No more than two (2) allocations will be made to the class.

 

TYPICAL EXAMPLES OF WORK (ILLUSTRATIVE ONLY)

 

            Conducts in-depth investigation of complex claims to secure facts; sends documents to claimants acknowledging receipt of the claim; investigates statements received by claimants; visits the scene of the accident or disaster such as cave-ins, explosions, water main breaks, and other catastrophes; evaluates the scope and extent of damage; canvasses scene for witnesses and obtains statements from witnesses, police, other City agencies and individuals; searches for and analyzes additional evidence; makes rough sketches of the scene indicating appropriate landmarks; directs the photographing of the scene or personally photographs the area.

            Identifies potential fraud and conducts suspect property damage (primarily suspicious theft and fire claims) and suspect medical/injury related investigations including but not limited to those involving staged/caused losses and provider impropriety;  follows course of action to substantiate a case for fraud to have claim dismissed; gathers and analyzes facts and develops evidence in each case of suspected fraud; conducts recorded interviews of claimants and witnesses obtaining oral and written statements, photographs or videos; documents evidence of suspected fraud. 

            Researches and interprets various statutes relating to municipal traffic regulations, general provisions of the Motor Vehicle Code, ordinances covering the water and sewer system; the tort laws in the Pennsylvania Bulletin, Medicare Set-aside laws and any other applicable legislation to determine relevance and/or application to claim being researched; applies pertinent legislation in the determination of liability.

            Examines City directories and public records to verify property ownership and related data; contacts representatives of City departments to obtain further information; prepares reports at various phases of the investigation; completes review and makes recommendations concerning the degree of liability and the claim value.

            Consults with the Law Department; negotiates with attorneys and claimants in an attempt to effectuate out-of-court settlements; secures answers to interrogatories prepared by counsel;  

            May supervise or assign work to lower level Claim Adjusters in the absence of the Claims Manager.

            Performs related work as required.

 

REQUIRED KNOWLEDGES, SKILLS AND ABILITIES

 

KNOWLEDGE OF:

 

•           the methods and techniques used in investigating and adjusting personal injury, property loss and damage claims

•           the laws and rules of evidence, judicial processes and specific principles of law and their application to personal injury, property loss and damage claims

•           methods, techniques, and equipment used in surveillance activities and taking photo­graphs

•           provisions of the PA Political Subdivision Tort Claims Act, PA Motor Vehicle Financial Responsibility Act, Motor Vehicle Code, municipal traffic regulations and ordinances covering the water and sewer system

•           building codes related to personal injury or property damage claims

•           interviewing techniques

 

SKILL IN:

 

•           eliciting and providing clear and concise information.

•           applying legal principles

•           negotiating property loss, personal injury and damage claims with attorneys and claimants

•           conducting fraud investigation

•           reviewing, understanding and interpreting insurance documents and medical records

 

ABILITY TO:

 

•           analyze and evaluate facts and evidence involving legal liability in order to effect proper adjustment and settlement of claims

•           obtain information through interviews, interrogations and observations and to record details accurately

•           manage and respond to urgency of complex claims

•           understand medical documentation and construction estimates related to personal injury or property damage claims

•           discern suspected fraud and pursue leads to dismiss claim

•           organize and express ideas effectively, both orally and in writing

•           establish and maintain effective working relationships with associates, other departments, experts, attorneys, witnesses and claimants

•           prepare narrative reports

•           secure the cooperation of others

•           perform photographic work of limited complexity

 

MINIMUM ACCEPTABLE TRAINING AND EXPERIENCE  (The following statement represents the minimum training and experience standards which will be used to admit or reject applicants for tests.  Applications submitted by candidates for this class will be reviewed based on training and experience requirements as approved on 1/12.)

 

EDUCATION:

 

            Completion of two years of course work at an accredited college or university.

 

AND

GENERAL EXPERIENCE:

 

            Three years of experience adjusting personal injury, property loss, and damage claims.

 

AND

SPECIFIC EXPERIENCE

 

            Two years of experience as a Claims Adjuster 2.

 

PHYSICAL AND MEDICAL REQUIREMENTS

 

            Ability to physically perform the duties and to work in the environmental conditions required of a position in this class.

 

LICENSES, REGISTRATIONS AND/OR CERTIFICATES

 

            Possession of a valid proper class motor vehicle operator's license as issued by the Commonwealth of Pennsylvania prior to appointment and during tenure of employment as a Claims Adjuster 3.

 

                                                                                                                 Class Established 1/12

                                                                                                                                                           

JL