Field Claims Adjuster (BI Claims) - San Antonio - H-E-B

Job Summary: Conducts all necessary investigations in a timely manner on all types of claims and RTW cases to determine the facts and / or activities resulting in expenses related to the reported incident or case.

Essential Functions / Process Responsibilities (other duties may be assigned)
- Investigating and analyzing all type of claims for work injury, property damage, bodily injury, or liability claims and RTW cases to determine the facts/plan of action to resolve claims and control expense.  

- Conducting customer relations and customer services to diffuse situations.

- Conducts investigations on all types of claims and RTW cases and provides recommendation for best course of action
- Reviews and interprets existing, new, or proposed OSHA regulations, updates to department staff as necessary
- Investigates and documents hazard reviews; analyzes, evaluates, and presents recommendations
- Coordinates litigation case management to ensure cost containment; attend trials when needed, reports on trial to management, ensures clear and concise communication between defense attorney and management
- Manage incident reports and determine appropriate action plan
- Communicates with all partners, customers and other third parties who have filed an incident report to determine an appropriate action plan and to provide the best possible customer service
- Reviews and evaluates reports of occupational injuries, determine eligibility, and administers any and all benefits due in accordance with the provisions of the Work Injury Benefit Plan
- Facilitates subrogation/recovery efforts from third parties responsible
- Coordinates the effective administration of the Return to Work Program
- Conducts more intensive investigations for referred cases
- Continuously reviews, sets, and monitors reserves to reflect appropriate levels of exposure
- Reviews and approves payments on all cases within assigned authority
- Ensure adequate reserving, communication, and effective resolution on attorney represented or litigated cases
- Serves as corporate representative, witness, etc.
- Facilitates property claims, work injury and general liability
- Instills a safety culture and supports all safety initiatives

Preferred Education and Experience
- A related degree or comparable formal training, certification, or work experience
- 3+ years of experience in claims-handling (case management involving medical, vocational, subrogation / recovery, return to work program, etc.)
- Current Casualty Lines Claims Adjuster license (17-02) through the Texas Department of Insurance
- Valid Texas driver's license, no DUI, and no more than 2 moving violations in last 2 years

Preferred Key Competencies
- Strong working knowledge of PPO utilization, medical terminology, etc.
- Understanding of project management processes
- Strong customer service and telephone skills
- Intermediate PC skills, including MS Office and a Claims Management System
- Bi-lingual (English / Spanish) skills (preferred)
- Ability to interface with regulatory agencies, division and corporate staff, professional associations, etc.

Physical and Other Requirements
- Function in a fast-paced, retail, office environment
- Travel by car or plane with overnight stays
- Work extended hours; sit for extended periods
- Available for emergency contact 24 hours a day

11-2015

LEG3232