Claims Adjuster Professional Trainee

New Mexico Mutual Casualty Company•Albuquerque, NM

About The Position

The Claims Adjuster Professional Trainee position introduces the individual to New Mexico Mutual’s workers’ compensation claims function over a one-year period. The trainee receives a comprehensive formal training program under the direct guidance and supervision of the claims training manager, with participation from claims management personnel and claims specialists. Following the initial training phase, the position adjudicates assigned claims in accordance with applicable acts, rules and regulations, case law, and company procedures. Claim complexity is assigned by the responsible claims manager based on the trainee’s training level and performance. Training covers claim investigation, compensability, policy coverage, statutory and case law, benefits analysis and payment, litigation, medical matters, and claims resolution. The position partners with employers, injured workers, and medical providers; administers benefits; manages litigation and claim resolution; and documents claim activity. It also handles reserves, filings, benefit payments, mediations, hearings, trials, and ongoing claim reviews in accordance with applicable requirements and company standards.

Requirements

Bachelor’s degree from an accredited college or university.
No prior claims handling experience is necessary.
Knowledge of MS Office, including Word, Advanced Excel, PowerPoint, and Outlook.
Adherence to New Mexico Mutual’s values and mission.
Effective communication and collaborative skills, and the ability to maintain positive working relationships.

Responsibilities

Investigate claims, assess compensability and policy coverage, analyze and administer benefits, and manage medical matters, litigation, and claim resolution.
Partner effectively and consistently with employers, injured workers, and medical providers.
Verify claim information, document claim history, take recorded statements from workers and witnesses, and coordinate medical care.
Document all claim activities in the claim management system.
Assign outside legal counsel and manage return-to-work strategies and other expert assignments.
After determining compensability, set and monitor reserves according to company policies and the worker’s injury.
Issue benefit checks and make benefit payments within statutory and established time frames and guidelines.
Apply state statutes and related case law, and comply with company claims standards, policies, and procedures.
Make required filings.
Prepare for, attend, and present a majority of mediations and hearings, and represent the company at trial.
Maintain a diary on all open claims, record relevant information to provide a clear history and audit trail, and set review dates according to claim complexity or standard review criteria.
Perform other duties as assigned.
Demonstrate the company’s values and mission, including Service Excellence, Trust, Ownership, One Team, and Boldness.
Develop and maintain positive working relationships through effective communication and collaboration.