1751 Field Case Manager (Claims Adjuster)- Des Moines, Quad Cities and Eastern Iowa

Summary: 
A Field Case Manager investigates claims against insurance or other companies for personal, casualty, or property loss or damages and attempts to effect out-of-court settlement with claimant.  He/she examines claim forms  and other records to determine insurance coverage, interviews, telephones, or corresponds with claimant and witnesses,  consults police and hospital records, and inspects property damage to determine extent of company’s liability, varying method of investigation according to type of insurance.  A Field Case Manager prepares reports of findings and negotiates settlement with claimant,  recommends litigation by legal department when settlement cannot be negotiated, may attend litigation hearings, analyzes insurance claims to determine extent of insurance carrier’s liability and settles claims with claimants in accordance with policy provisions, compares data on claim applications, death certificate or physician’s statement with policy file and other company records to ascertain completeness and validity of claim.  This employee communicates with insured’s, claimants, and agents in writing, verbally or by interview in order to accomplish the investigation of routine and questionable claims. He/she pays claimant amount due.  He/she is capable of handling the most complex type of claims.  He/she reviews settled insurance claims to determine that payments and settlements have been made in accordance with company practices and procedures, analyzes data used in settling claim to determine its validity in payment of claims, reports overpayments, underpayment, and other irregularities, confers with legal counsel on claims requiring litigation, directs and coordinates activities of branch or district office of insurance company, agency or insurance brokerage firm, hires and trains workers in performing activities, such as processing insurance claims,  reviews activity reports to ensure that personnel have achieved quotas and processed claims promptly, confers with company officials to plan and develop methods and procedures to increase productivity, lower costs, obtain greater efficiency, interprets, implements and enforces company policies.  A Field Case Manager prepares and submits activity reports, supervises and coordinates activities of workers engaged in examining insurance claims for payment in claims division of insurance company, analyzes and approves insurance claims, conducts personal interviews with policy owners for procedure for filing claims, informs supervisor on claim status, evaluates job performances of subordinates, supervises the claims staff and clerical staff and assists with marketing functions.  Continuing education is required of the Field Case Manager.

Essential Duties and Responsibilities: (These include the following and other duties may which be assigned.)
   
The Claims Manual will address such issues as proper investigation procedures.  In all cases, where the company policy does not specify the procedure for a particular situation, best claims practices will be utilized to insure the same emphasis on ethical conduct as dictated in the Claims Manual.  This person must be available to work 24 hours a day, 7 days a week and be capable of being on call. This person may be granted settlement authority up to a certain threshold. The Field Case Manager may be required to work with and/or train a Field Case Representative Trainee, Field Case Representative or Senior Field Case Representative, as well as supervising claims and clerical staff. 

Qualifications:
 To perform this job successfully, an individual must be able to perform each essential duty satisfactorily.  The requirements listed below are  representative of the knowledge, skill, and/or ability required.  Reasonable accommodations may be made to enable individuals with disabilities to  perform the essential functions.

Education/Experience:
 Bachelor’s degree (B.A.) from four-year college or university, with three to five years related experience; or six to twelve years related experience  and/or training; or equivalent combination of education and experience.

Language Ability:
 Ability to write letters, summaries and reports using prescribed formats and basic rules of grammar.  Excellent verbal communication skills are  required, to include a good understanding of the industry terminology.

Math Ability:
 Ability to make basic calculations and utilize resources to complete complicated mathematical equations, formulas, etc., to assist with investigation  or benefit computations.

Reasoning Ability:
 Apply principles of rational systems to solve practical problems and deal with a variety of concrete variables in situations where only limited  standardization exists.  Interpret a variety of instructions furnished in written, oral diagrammatic, or schedule form.  Apply principles of logical or  scientific thinking to define problems, collect data, establish facts, and draw valid conclusions.  Interpret an extensive variety of technical  instructions in mathematical or diagrammatic form.  Deal with several abstract and concrete variables.

Computer Skills:
 Basic use of Windows XP, GroupWise, Microsoft Office (particularly Word and Excel).

Certificates and Licenses:
 Must meet any and all licensing requirements mandated by his/her state workers’ compensation authority.
 

Supervisory Responsibilities:
 May be responsible for the overseeing a small unit of employees.