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CLAIMS SPECIALIST, WORKERS COMP

Job Title: CLAIMS SPECIALIST, WORKERS COMP
Job Code: 2391
FLSA: E
Job Level: 12
Revised Date: 07/01/2016
Job Family: JF 28

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Occupational Summary

Coordinate and administer a variety of activities associated with determining validity, assessing liability and risks, and negotiating monetary settlements for claims related to workers' compensation claims.

Work Performed

Coordinate and administer a variety of activities associated with determining validity, assessing liability and risks, and negotiating monetary settlements for workers' compensation cases involving occupational illness or injury.

Investigate claims through direct contact with employees, supervisors and other witnesses as appropriate to collect information regarding incidents; explain process to claimant; collect data from Employee Occupational Health Services; determine if case is compensable; interact with various external persons such as insurance adjusters, attorneys, physicians and other parties to coordinate the mediation, settlement and processing of claims; document findings.

Establish and adjust claims reserves as required to comply with appropriate regulations.

Negotiate settlement for cases falling within established guidelines; make recommendations on cases not settled through negotiation; assist the legal counsel in the preparation of materials and evidence for use in North Carolina Commission hearings.

Compile information regarding incidents and related medical expenses, and prepare ongoing reports as required by state law and established departmental procedures; submit reports to the North Carolina Industrial Commission by designated deadlines.

Coordinate with rehabilitation coordinator, as appropriate, to assist employees in the return to work.

Participate in internal and external conferences or other groups to keep abreast of current developments in safety techniques, methods and programs and the North Carolina Industrial Commission and Compensation Act.

Perform other related duties incidental to the work described herein.

The above statements describe the general nature and level of work being performed by individuals assigned to this classification. This is not intended to be an exhaustive list of all responsibilities and duties required of personnel so classified.

Required Qualifications at this Level

Education/Training

Work requires a communications, analytical and organizational skills generally acquired through the completion of a bachelor's degree program.

Experience

Work generally requires 2 years of experience in insurance, a safety related position such as workers compensation claims adjuster, commercial casualty claims adjuster, insurance investigator, safety officer, or related occupation to gain knowledge of insurance claims experience and to acquire skills necessary to coordinate a variety of activities associated with assessment and settlement of claims.

Valid North Carolina Claims Adjuster license also required.

OR AN EQUIVALENT COMBINATION OF RELEVANT EDUCATION AND/OR EXPERIENCE

Skills


The intent of this job description is to provide a representative and level of the types of duties and responsibilities that will be required of positions given this title and shall not be construed as a declaration of the total of the specific duties and responsibilities of any particular position. Employees may be directed to perform job-related tasks other than those specifically presented in this description.


Duke University is an Affirmative Action/Equal Opportunity Employer committed to providing employment opportunity without regard to an individual's age, color, disability, gender, gender expression, gender identity, genetic information, national origin, race, religion, sex, sexual orientation, or veteran status.

Duke aspires to create a community built on collaboration, innovation, creativity, and belonging. Our collective success depends on the robust exchange of ideas-an exchange that is best when the rich diversity of our perspectives, backgrounds, and experiences flourishes. To achieve this exchange, it is essential that all members of the community feel secure and welcome, that the contributions of all individuals are respected, and that all voices are heard. All members of our community have a responsibility to uphold these values.


Essential Physical Job Functions

Certain jobs at Duke University and Duke University Health System may include essential job functions that require specific physical and/or mental abilities. Additional information and provision for requests for reasonable accommodation will be provided by each hiring department.