Claims Adjuster I

Job Summary: p style="margin: 0px;"span style="font-family: arial, helvetica, sans-serif; font-size: 10pt;"strongGENERAL DESCRIPTION/strong/span/pp style="margin: 0px;"span style="font-size: 10pt; font-family: arial, helvetica, sans-serif;"Plans, carries out, and/or coordinates most the work required to process an insurance claim.  Confirms alleged circumstances/property damage/employee injury. Reviews policy for determination of coverage. Investigates and compiles claims documentation/evidentiary support. Coordinates respective services with providers/TPA. Obtains authorization for settlements/action plans. Prepares analysis/reports on findings, activities, claims history, etc. Maintains records./span/p Job Duties: p style="margin: 0px;"strongspan style="font-size: 10.0pt; font-family: 'Segoe UI',sans-serif;"ESSENTIAL DUTIES AND RESPONSIBILITIES/span/strong/pulli style="margin: 4.0pt 0in 4.0pt .5in;"span style="font-size: 10.0pt; font-family: 'Segoe UI',sans-serif;"Reviews policy to determine application of coverage and eligibility. /span/lili style="margin: 4.0pt 0in 4.0pt .5in;"span style="font-size: 10.0pt; font-family: 'Segoe UI',sans-serif;"Conducts interviews with all parties/witnesses./span/lili style="margin: 4.0pt 0in 4.0pt .5in;"span style="font-size: 10.0pt; font-family: 'Segoe UI',sans-serif;"Interprets insuring contracts, endorsements, and exclusions. /span/lili style="margin: 4.0pt 0in 4.0pt .5in;"span style="font-size: 10.0pt; font-family: 'Segoe UI',sans-serif;"Develops action plans, coordinates service providers and obtains authorization by management for implementation for said plans. /span/lili style="margin: 4.0pt 0in 4.0pt .5in;"span style="font-size: 10.0pt; font-family: 'Segoe UI',sans-serif;"Coordinates/conducts interviews with insured, claimants, witnesses, medical providers, attorneys, etc. to identify and compile important documents/evidentiary support./span/lili style="margin: 4.0pt 0in 4.0pt .5in;"span style="font-size: 10.0pt; font-family: 'Segoe UI',sans-serif;"Maintains records and files accordingly to be used in legal/court proceedings. /span/lili style="margin: 4.0pt 0in 4.0pt .5in;"span style="font-size: 10.0pt; font-family: 'Segoe UI',sans-serif;"Appears and testifies in court proceedings, give verbal depositions, attends meetings as warranted, and works closely with attorneys. /span/lili style="margin: 4.0pt 0in 4.0pt .5in;"span style="font-size: 10.0pt; font-family: 'Segoe UI',sans-serif;"Prepares reports on investigative findings, court proceeds, Arbitration, Appeals, claims activity, frequency/severity, large claims and coverage/service issues on a routine/regular basis. /span/lili style="margin: 4.0pt 0in 4.0pt .5in;"span style="font-size: 10.0pt; font-family: 'Segoe UI',sans-serif;"Prepares audit schedule includes of all insured entities. /span/lili style="margin: 4.0pt 0in 4.0pt .5in;"span style="font-size: 10.0pt; font-family: 'Segoe UI',sans-serif;"Generates accurate reports and statistical data for all insureds covered under the Cherokee Nation Workers' Compensation Act and/or insurance policies, recommends legislative action to mitigate coverage issues. /span/lili style="margin: 4.0pt 0in 4.0pt .5in;"span style="font-size: 10.0pt; font-family: 'Segoe UI',sans-serif;"Serves on various committees, TWCA, etc. /span/lili style="margin: 4.0pt 0in 4.0pt .5in;"span style="font-size: 10.0pt; font-family: 'Segoe UI',sans-serif;"Monitors claims activities to ensure quality of claims service providers and frequently communicates with all parties involved with the claim. /span/lili style="margin: 4.0pt 0in 4.0pt .5in;"span style="font-size: 10.0pt; font-family: 'Segoe UI',sans-serif;"Bills, reconciles, and reports on billing of program deductibles within self-insured layer. /span/lili style="margin: 4.0pt 0in 4.0pt .5in;"span style="font-size: 10.0pt; font-family: 'Segoe UI',sans-serif;"Tracks payments from TPA/Reinsurer to ensure 100% recovery of large claims. /span/lili style="margin: 4.0pt 0in 4.0pt .5in;"span style="font-size: 10.0pt; font-family: 'Segoe UI',sans-serif;"Schedules deposits/offsets to Loss Fund and Fringe./span/lili style="margin: 4.0pt 0in 4.0pt .5in;"span style="font-size: 10.0pt; font-family: 'Segoe UI',sans-serif;"Maintains all confidential filing system. /span/lili style="margin: 4.0pt 0in 4.0pt .5in;"span style="font-size: 10.0pt; font-family: 'Segoe UI',sans-serif;"Performs all billing, accrual, and reserving tasks/reporting. /span/lili style="margin: 4.0pt 0in 4.0pt .5in;"span style="font-size: 10.0pt; font-family: 'Segoe UI',sans-serif;"Determines maximum out of pocket expenses by applying Loss Development Factors (LDF) and trending for inflation. /span/lili style="margin: 4.0pt 0in 4.0pt .5in;"span style="font-size: 10.0pt; font-family: 'Segoe UI',sans-serif;"Generates reserving and ALA Performance report to management. Records are audited annually by external CPA firms and funding agencies./span/lili style="margin: 4.0pt 0in 4.0pt .5in;"span style="font-size: 10.0pt; font-family: 'Segoe UI',sans-serif;"Generates and maintains Stop Loss graphs/tables and reports./span/lili style="margin: 4.0pt 0in 4.0pt .5in;"span style="font-size: 10.0pt; font-family: 'Segoe UI',sans-serif;"Compiles and produces and maintains Ultimate Value of Losses to be utilized when management entertains Commutation Agreement on open loss year. /span/lili style="margin: 4.0pt 0in 4.0pt .5in;"span style="font-size: 10.0pt; font-family: 'Segoe UI',sans-serif;"Writes and participates in groups that author or recommend amending tribal law/legislation/policy. /span/lili style="margin: 4.0pt 0in 4.0pt .5in;"span style="font-size: 10.0pt; font-family: 'Segoe UI',sans-serif;"Attendance must comply and be maintained in compliance with unit operating policies. /span/lili style="margin: 4.0pt 0in 4.0pt .5in;"Other duties/projects as assigned./li/ul Qualifications: p style="margin: 0px;"span style="font-family: arial, helvetica, sans-serif; font-size: 10pt;"strongQUALIFICATIONS/strong/span/pulli style="margin: 4.0pt 0in 4.0pt .5in;"span style="font-size: 10pt; font-family: arial, helvetica, sans-serif;"Bachelor's degree from 4-year college or university; or six years related experience or equivalent combination of education and experience. /span/lili style="margin: 4.0pt 0in 4.0pt .5in;"span style="font-size: 10pt; font-family: arial, helvetica, sans-serif; background-color: #00ff00;"At least three years direct experience in related field./span/li/ulp style="margin: 0px;"span style="font-size: 10pt; font-family: arial, helvetica, sans-serif;"strongPHYSICAL REQUIREMENTS/strong/span/pp style="margin: 0px;"span style="font-size: 10pt; font-family: arial, helvetica, sans-serif;"While performing the duties of this Job, the employee is regularly required to sit and talk or hear. The employee is frequently required to use hands to finger, handle, or feel; reach with hands and arms and stoop, kneel, crouch, or crawl. The employee is occasionally required to stand; walk; climb or balance and taste or smell. The employee must regularly lift and /or move up to 10 pounds, frequently lift and/or move up to 25 pounds and occasionally lift and/or move up to 50 pounds.  Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception and ability to adjust focus./span/pp style="margin: 0px;" /pp style="margin: 3.0pt 0in 3.0pt 0in;"span style="font-family: arial, helvetica, sans-serif; font-size: 10pt;"strongCERTIFICATES, LICENSES, REGISTRATIONS/strong/span/pulli style="margin: 4.0pt 0in 4.0pt .5in;"span style="font-size: 10pt; font-family: arial, helvetica, sans-serif;"Must obtain Oklahoma Adjuster’s License within 6 months of employment in position./span/lili style="margin: 4.0pt 0in 4.0pt .5in;"span style="font-size: 10pt; font-family: arial, helvetica, sans-serif;"Adjuster’s License shall be maintained in good status throughout employment in said position./span/li/ulp style="margin: 3.0pt 0in 3.0pt 0in;"span style="font-family: arial, helvetica, sans-serif; font-size: 10pt;"strongOTHER REQUIREMENTS/strong/span/pp style="margin: 3.0pt 0in 3.0pt 16.5pt;"span style="font-size: 10pt; font-family: arial, helvetica, sans-serif;"The employee must not be and will not be under sanction by the United States Department of Health and Human Services Office of the Inspector General (OIG) or by the General Services Administration (GSA) or listed on the OIG's Cumulative Sanction Report, or the GSA's List of Excluded Providers, or listed on the OIG's List of Excluded Individuals/Entities (LEIE)./span/pp style="margin: 3.0pt 0in 3.0pt 16.5pt;" /pp style="margin: 3.0pt 0in 3.0pt 16.5pt;"span data-teams="true"strongIf you would like to schedule time to speak on-line with a Human Resources Recruiter to discuss your application/resume, please click here, /stronga aria-label="Link Book time with a Recruiter" href="https://outlook.office.com/bookwithme/user/baea36cdd0e247eeadd7a56f884f129f@cherokee.org?anonymousep=pcard" target="_blank" title="https://outlook.office.com/bookwithme/user/baea36cdd0e247eeadd7a56f884f129f@cherokee.org?anonymousep=pcard" class="fui-Link ___1q1shib f2hkw1w f3rmtva f1ewtqcl fyind8e f1k6fduh f1w7gpdv fk6fouc fjoy568 figsok6 f1s184ao f1mk8lai fnbmjn9 f1o700av f13mvf36 f1cmlufx f9n3di6 f1ids18y f1tx3yz7 f1deo86v f1eh06m1 f1iescvh fhgqx19 f1olyrje f1p93eir f1nev41a f1h8hb77 f1lqvz6u f10aw75t fsle3fq f17ae5zn" rel="noopener"strongBook time with a Recruiter/strong/a/span/p