Claims Specialist

Claims Specialist

This is a professional and responsible administrative position with the primary responsibility of effectively managing the City's workers' compensation, general liability, auto liability, and property claims. This classification is responsible for liaising with city employees, supervisors, and managers. This position also coordinates with legal representatives, insurance companies, medical and rehabilitation facilities / staff / and / or physicians. Furthermore, this individual is responsible for managing the filing of workers' compensation, general liability, and auto liability claims, as well as working with a contracted third-party administrator that processes the City's self-insured risk claims. This position interconnects daily with adjusters on matters related to healthcare, including approved providers, pharmacy charges, and the review and request of medical records and reports. This position supervises the work of two Risk Management Assistants. The incumbent has wide latitude for independent action and discretion in performing assigned duties and is normally expected to complete all functions with general direction.

Essential functions include reviewing and evaluating all new claims regarding settlement or denial and presenting to authorized decision makers. Consider settlement negotiations with attorneys and insurance companies. Supports and assists the Director in ensuring departmental compliance and supporting the City's strategic plan. Manages response and preparation of legal defense materials and documentation produced for litigation. Acts as liaison with employees, adjusters, and legal representatives during claims processing, negotiation, closure, and settlements. Develops, analyzes, and presents complex claims reports. Analyzes data on all losses to determine causes and recommends corrective actions to prevent future losses. Reviews and prepares authorization approvals or schedules information for various insurance claim payments. Tracks and reports claim trends and reports key information critical to the operation to the Director, Risk Manager, and department. Represents the City at claims-related depositions, mediations, hearings, and trials. May be required to participate in and / or facilitate training to support departmental or City initiatives and requirements. May be required to work alternate hours as necessary for the efficient operation of the department. Position is designated as Mission Critical.

Additional functions include performing related work as required.

Required qualifications include a Bachelor's degree from an accredited four-year college or university, five years of progressively responsible claims experience in workers' compensation insurance and / or auto / property casualty insurance, and one year of leadership experience providing mentorship, direction, and guidance to staff, including assigning work and ensuring follow-up on tasks. An equivalent combination of education, training, and experience that provides the necessary knowledge, skills, abilities, and other competencies necessary for success in the target position may be considered.

Special requirements include possessing and maintaining a valid driver's license and a valid telephone number. A Florida All Lines Adjuster License is preferred.

Knowledge, skills, abilities include coordinating with insurance representatives, attorneys, physicians, and claimants in satisfactorily resolving claims, making necessary investigations regarding loss experiences and taking the necessary action to ensure the exposure is reduced or eliminated. This position requires integrity, confidentiality, sound judgment, and strong decision-making skills.

The job requires sedentary work with occasional walking or standing, exerting up to 10 pounds of force regularly, and performing routine keyboard operations. The job risks exposure to traffic and possible exposure to hazardous atmospheric conditions. The job requires normal visual acuity, field of vision, hearing, speaking, color perception, sense of taste, sense of smell, depth perception, and texture perception.

All City of Lakeland positions are subject to testing (e.g. written, oral, performance, computerized, interview, and / or any combination). Candidates selected for testing will be notified via email or telephone. Please check your e-mail and telephone messages regularly, including "junk" folders. Test times and locations to be announced.

The City of Lakeland is an equal opportunity / equal access employer and a drug free workplace.