Claims Adjuster

Job ID:

240292

Location:

MD-Metro Bldg New Carrollton

Full/Part Time:

Full-Time

Posting Open-Close

07/01/2024

-

07/14/2024

Union

002

Regular/Temporary:

Regular

Job Description

General Hybrid Work Statement:

This opportunity is a hybrid opportunity allowing for flexibility between virtual and in-person work subject to the Authority’s telework policy.

Marketing Statement:

The Claims Adjuster is responsible of assisting the Claims Manager with the management, preparation, formulation, review, and execution of the Authority’s Third-Party Liability Unit (TPL) subrogation and complex/large claims. The scope of the TPL unit employs the latest in industry techniques and procedures per the Authority and established Risk procedures and requirements. The incumbents work responsibilities include, reporting, recording, and analyzing claims and self-insured data. This responsibility involves making decisions as to realistic values of claims and certifies settlement of claims within the approved authority level. The incumbent is knowledgeable in Central Index Bureau (CIB) reporting, the National Crime Institute (NCI), fraud awareness, fraud investigation, and structured settlements.

Minimum Qualifications

Education

• Bachelor’s degree in Risk Management, Finance, Business Administration, or related field of study

Experience

• Minimum ten (10) years liability claims investigation experience

Certification/Licensure

• N/A

Preferred

• Professional claims or insurance designations (e.g., AIC, PCA, ARM, etc.)

• Claims Adjuster license

Medical Group

Satisfactorily complete the medical examination for this position, if required. The incumbent must be able to perform the essential functions of this position either with or without reasonable accommodations.

Job Summary

The Claims Adjuster is responsible for investigations, evaluations, negotiations, management and disposition of Third-Party claims filed against WMATA. The Claims Adjuster manages a range of claims involving bodily and property damage by third parties, which may include serious injuries and/or death. The incumbent works closely with WMATA attorneys in defending claims in litigation; pursues subrogation claims against parties causing injury or damage to WMATA property; and utilizes authorized settlement authority to bring claims to closure. The incumbent has a thorough working knowledge of managing claims using the Risk Management Information System (RMIS). The Claims Adjuster’s accountabilities also include designing customized personal dashboards, creating custom reports, database queries, reporting claim trends analyses to internal customers using RMIS. The incumbent possesses advanced expertise in liability insurance, as well as specific expertise in DC, MD and VA liability laws and statutes.

Essential Functions

• Secures, investigates, and examines facts surrounding accidents. The facts include accident reports, police reports, witness interviews, scene investigations, diagrams, photos, video records, medical bills/reports, vehicle damage estimates, recorded statements, and expert analysis when needed, to determine if, and to what extent, WMATA is responsible for injury or property damage caused to a third party, and establishes the probable cost of the claim. All claim aspects are handled within the RMIS environment to support the compensation for the injured third parties. These facts are legally required for bodily injury and/or property damage caused by WMATA, to ensure WMATA’s liabilities are accurately reflected in the general ledger.

• Ensures that all reports, videos (i.e., DriveCam and/or CCTV), correspondence, medical reports, invoices and other claim-related documents are uploaded into the RMIS claim file (viewing videos ASAP after the incident date is key to determining liability). Documents all completed and planned activities in the RMIS file notes and sets task dates for next steps in working the claim. Uploads and manages videos into MS Teams, Origami, or any other database used in claims handling. The packaging ensure that all relevant facts and documents are captured in the RMIS claim record as the basis of a denial or acceptance of the claim.

• Prepares disposition plans to facilitate proactive negotiations within 14 days of the completed evaluations. Uses independent judgment within settlement authority granted, and promptly requests additional authority as needed to ultimately resolve, close the claim, and ensure claimants are fairly compensated for their damages.

• Facilitates roundtable discussions with or without the Office of General Counsel (COUN) to review unusual or serious claims and identify settlement tactics. A variety of opinions and knowledge are deployed to arrive at a reasonable and prudent claim resolution.

• Prepares litigation referrals for COUN and assists with trial preparation and testimony as needed.

• Pursues subrogation recoveries against responsible parties causing damage to WMATA assets, to compensate WMATA for the cost to repair or replace damaged WMATA property.

The essential duties listed are not intended to limit specific duties and responsibilities of any particular position. Nor is it intended to limit in any way the right of managers and supervisors to assign, direct and control the work of employees under their supervision.

Evaluation Criteria

Consideration will be given to applicants whose resumes demonstrate the required education and experience. Applicants should include all relevant education and work experience.

Evaluation criteria may include one or more of the following:

• Skills and/or behavioral assessment

• Personal interview

• Verification of education and experience (including certifications and licenses)

• Criminal Background Check (a criminal conviction is not an automatic bar to employment)

• Medical examination including a drug and alcohol screening (for safety sensitive positions)

• Review of a current motor vehicle report

Closing

WMATA is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, status as a protected veteran, or any other status protected by applicable federal law.

This posting is an announcement of a vacant position under recruitment. It is not intended to replace the official job description. Job descriptions are available upon confirmation of an interview.