CLAIMS REPRESENTATIVE

Investigate and adjust entry level or moderately complicated injury claims interacting with claimants, health care providers, union representatives, attorneys, and others to successfully make proper decisions on files and bring files to conclusion.

• Investigate and adjust worker’s compensation claims to determine correct action to be taken.
• Contact injured employees, witnesses, employing departments and others to obtain information surrounding the circumstances of the accident, and obtaining written/recorded statements.
• Contact the disabled, injured employee at appropriate time frames (either orally or in writing) to determine medical condition and status of claims and coordinate return to work.
• Contact medical providers (orally and in writing) to determine current medical status of the injured employees and coordinate a return to work date.
• Review medical reports to determine compensability of claim.
• Review medical bills and make payments in accordance with industry standards (30 days).
• Calculate indemnity payments according to Worker’s Compensation Law and make payments within appropriate State requirements.
• File appropriate State reports within time frames as set up by the Worker’s Compensation Act.
• Review incoming mail timely and make appropriate decisions.
• Perform other duties directed/assigned by the Worker’s Compensation Management and follow established procedures.
• Reserve Claims within authority limit.
• Identify possible subrogation options and protect the City’s interest.
• Maintain inventory at acceptable levels using effective Case Management.

Reasonable accommodations requested by qualified individuals with disabilities will be made in accordance with the Americans with Disabilities Act (ADA) of 1990, as amended by the Americans with Disabilities Act Amendments Act (ADAAA) of 2008.

1.     Four years of high-level technical office experience, including two years in worker's compensation or insurance performing customer service and claims approval or adjusting functions.

Note: Equivalent combinations of related education and experience may also be considered.  

IMPORTANT NOTE: To receive credit for college, transcripts are required and must be received by the application period closing date. College transcripts should be attached to your online application. Applications without transcripts attached will be considered incomplete and will be rejected.

2.     Valid Driver’s License at time of appointment and throughout employment.

• Insurance claims adjusting experience in health, automobile, liability, or worker's compensation.

• Knowledge of Wisconsin Worker’s Compensation Law and other related rules and regulations.
• Knowledge of medical terminology.
• Knowledge of computer word processing, data base, and presentation software.
• Skill to give full attention to what other people are saying and actively listening.
• Ability to combine pieces of information to form general conclusions.
• Ability to apply general rules to specific problems to produce logical answers.
• Ability to apply Worker’s Compensation law to everyday claims adjusting work.
• Ability to utilize computer software to analyze data, create detailed reports, and communication documents.
• Ability to listen, understand, and gather critical information during case investigations.
• Ability to work independently to accomplish workload.
• Ability to communicate information and ideas in an understandable spoken form to customers, coworkers, and supervisor.
• Ability to communicate information presented in written reports, forms, briefs, and email to customers, coworkers, and supervisor.

SALARY (PR5FN) The current starting salary is $40,516 annually for City of Milwaukee residents.  The non-resident starting salary is $39,522.

THE SELECTION PROCESS will be job related and will consist of one or more of the following: education and experience evaluation; written, oral, or performance tests, or other assessment methods. The Department of Employee Relations reserves the right to call only the most qualified candidates to oral and performance examinations. Oral examinations may include written exercises. Selection process component weights will be determined by further analysis of the job.  

INITIAL FILING DATE – The examination will be held as soon as practical after September 1, 2015. Receipt of applications may be discontinued at any time after this date without prior notice. However, recruitment may continue until the needs of the City have been met. Qualified applicants will be notified of the date, time, and place of the examination. Unless otherwise required by law, the City of Milwaukee will not provide alternative test administration. The applicant is responsible for attending all phases of the job selection process at the time and place designated by the City of Milwaukee.

NOTE: The City’s residency requirement set forth in City Charter 5-02 is under litigation. Even though the City is legally able to enforce the current residency requirements based on a recent Wisconsin Court of Appeals decision, the City has agreed to continue to suspend enforcement of the ordinance during the time it may take to know whether the Wisconsin Supreme Court will review the case.  Once the Supreme Court refuses review or affirms the Court of Appeals decision, the City intends to fully enforce the ordinance. Consequently, employees who disregard the requirements of the ordinance do so at their own risk. Applicants for City of Milwaukee positions should understand the City’s commitment to its residency requirement. During this period of uncertainty it is important to take that into account when submitting an application and more importantly when deciding to accept an employment offer.  Please contact (414) 286–3751 if you have questions regarding your individual circumstances as part of the application and/or selection process.

APPLICATIONS and further information may be accessed by visiting, http://city.milwaukee.gov/jobs

• Applications and transcripts should be submitted no later than the deadline listed above.
• If you would like assistance completing an application, please contact the Department of Employee Relations at (414) 286-3751 or staffinginfo@milwaukee.gov.
• The Department of Employee Relations is located at City Hall, 200 E. Wells St, Room 706, Milwaukee, WI 53202.