Claims Adjuster

Job ID
2018-1250
Category
Risk Management
Type
Regular Full-Time
Starting Pay Range
$42,942 - $50,440/yr exempt

Basic Purpose

Plans, organizes, and processes all property, vehicle liability, and general liability claims through to litigation activities, and the management of all workers’ compensation claims activities for the efficient operation of PSTA’s Multi-Line Insurance program.

 

Assist with PSTA’s safety and environmental (EPA) programs, maintain compliance with federal, statutory regulations, and local laws or ordinances, and assist with the identification of potential fraud in the claims administrative/insurance process.

Essential Functions

Assist with financial, technical, and legal requirements for administrating PSTA’s multi-line insurance program and Risk Management Program. Assist with maintaining appropriate internal controls. This will require the implementation of the requirements of Florida Statute Chapter 440, Florida’s Tort Statutory requirements, federal and local laws or ordinances, including risk management principals, practice and computer technology.  

 

Manage PSTA’s general liability, casualty, and property damage claims through the investigation process, including incident site analysis. Work with PSTA’s Employees, Insurers, Legal Counsel, Claimants and their Attorneys, during the claim resolution process and maintain compliance with Florida’s Statutory Regulations and PSTA’s Polices/Procedures. Work with compliance documentation for claims in PSTA’s Risk Management Information System and identify potential claims and existing claims through the Digital Video Review (DVR) process. This may involve the securing of the DVR or images from the buses for appropriate claim management and ensuring that the DVR is secured for all legal proceedings.

 

Work in coordination with Human Resources, and Safety, Security and Training, to assist in field evaluations and inspections of PSTA property and equipment to identify, appraise, correct work hazards and/or determine loss potential.  Investigate and/or review accidents and injuries involving employees, visitors, or passengers. Communicate to appropriate departments any exposures identified by the Risk Management Department. 

 

Complete RIMS/CSSTARS financial payments for General Liability, Property, and Vehicle Program which are coordinated through the Chief Financial Officer.

 

Manage all PSTA workers’ compensation claims. This includes the processing and investigation of all initial workers’ compensation claims, coordination with PSTA’s third party administrators, meet statutory reporting guidelines and identify potential employee exposures during the workers’ compensation process; i.e. with policy and procedures, employee changes, and the investigative process. This program includes the completion of the documentation with the electronic submission of the employee’s First Report of Injury/Illness, Wage Statements, and other forms required by the workers’ compensation statutory program, third party administrators and/or treating providers.

 

Educate employees regarding their basic rights and responsibilities as an injured worker, and refer employees to PSTA’s third party administrator for additional information. Coordinate PSTA’s workers’ compensation return-to-work program; including all Modified Duty assignments, insuring initial and follow-up medical treatments are completed and compliant. Serve as a liaison between PSTA and its third-party administrator to assure performance compliance for reporting. Maintain and monitor lost time work status updates, and communicate entire process with the employee’s Management Team,  Risk Management Team, medical team and third-party administrators, including adjusters.

 

Assist Risk Management in the litigation process for mediations, hearings and conferences as required. These actions may include the deposition of the Claims Adjuster or court interactions.

 

Assist in the development and completion of statistical reports and management summaries. Participate in the update, development or implementation of policies and procedures relating to Risk Management, safety (OSHA), loss control and loss prevention. This includes the potential design, development, and maintenance of records to maintain the workers’ compensation program, the General Liability Program, financial records, subrogation program, claims management tools, Digital Video Recorder Program as required.

 

Attend conferences, workshops, and meetings to keep abreast of new developments or changes in law pertaining to the industry.

 

Assist with the Risk Management Team with any other duties assigned.

Minimum Qualifications

Education: Associate Degree and/or Bachelor’s Degree in Business or related field preferred. Certifications and Licensing in related fields are considered.

 

Experience: Minimum of two years’ work experience in Risk Management, and/or All Lines Adjuster experience in either General Liability, Vehicle, Property or Workers’ Compensation.  Experience should include information systems, business theory, and practices, or insurance.  Demonstrate some knowledge of risk management techniques such as risk identification, risk finance, risk control, safety and loss control.

 

License Requirement: All Lines Adjuster license required.  Valid Florida Driver’s License required.

 

KNOWLEDGE, SKILLS AND ABILITIES

Knowledge: Familiar with basic information for administrating a self-insurance plan and risk management program. These include Florida’s Workers’ Compensation, internal controls and federal, state, and local laws, including computer technology, with hardware and system experience (i.e. laptop computers, compact disc (CD).

 

Skills:  Organization skills. Ability to communicate effectively both orally and written. Use of computers and various software, including Word, Excel, and Access.

 

Abilities:  Ability to maintain and analyze statistical and factual reports, exercise sound judgment and determine appropriate action. Exercise keen initiatives and work independently. Investigation of accident scenes when needed. Assist management with the development of management reports related to risk exposures with corrective actions recommendations.

 

 PSTA is an Equal Employment Opportunity Employer.

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