Claims Specialist

State-of-Missour; Jefferson City (MO); On-site; USD 52,000 - 68,000; Full time

Job summary

The State of Missouri’s Division of Workers’ Compensation seeks a detail-oriented reviewer to assess eligibility and award compensation from multiple funds. You will analyze claims, medical records, and supporting documentation, and prepare rulings with attention to statutory requirements.

Strong knowledge of personal injury, liability and insurance concepts is required, along with proficiency in Adobe DC and Excel.

Qualifications

• Bachelor’s degree OR 4 years of relevant experience in related fields.
• Knowledge of personal injury claims, insurance coverage issues and liability.
• Ability to apply Missouri statutes and review medical records.

Responsibilities

• Evaluate and determine eligibility and awards from Tort Victims Compensation Fund.
• Review documentation, determine eligibility, and award from Line of Duty Fund.
• Prepare determinations for MFD Administrative Rulings.
• Prepare determinations for Second Injury Fund Rehab Benefit.
• Facilitate mediation discussions for minor issues in workers’ compensation cases.
• Respond to inquiries from Governor’s Office or Missouri Legislature.
• Answer phone calls and emails promptly.
• Support Division’s modernization efforts.
• Other duties as assigned.

Skills

Personal injury claims knowledge

Insurance coverage issues

Ability to interpret statutes

Mediation training/experience

Communication with stakeholders

Education

Bachelor's Degree in Risk Management, Business Management, or Public Administration

4 years of relevant experience in personal injury/auto/general liability

Tools

Adobe DC

Microsoft Office Suite (Excel)

Job description

The Division of Workers’ Compensation offers a dynamic, energetic and engaging environment to flourish and demonstrate operational excellence. The Division is modernizing its internal and external processes and procedures, and there is an immense opportunity to contribute to an exciting, forward-thinking, fast-moving, collaborative environment. As part of the team, you will enjoy the genuine spirit of cooperation and shared goals revolving around helping Missouri’s citizens.

• Evaluate and make determinations of eligibility and awarded compensation from the Tort Victims Compensation Fund
• Review claim and supporting documentation, determine eligibility, and award compensation from the Line of Duty Fund
• Review documentation and prepare determinations for Medical Fee Dispute (MFD) Administrative Rulings
• Review documentation and prepare determinations for Second Injury Fund (SIF) Rehab Benefit
• Facilitate mediation discussions for minor issues with parties to workers’ compensation cases
• Respond to constituent inquiries received by the Governor’s Office or the Missouri Legislature
• Promptly answer phone calls and emails received
• Support the Division’s Modernization efforts
• Other duties as assigned

Qualifications

• Bachelor's Degree in Risk Management, Business Management, or Public Administration OR 4 years of relevant experience with personal injury, auto liability, or general liability.

Lack of post‑secondary education will not be used as the sole basis denying consideration to any applicant.

Desired Attributes

• Working knowledge of personal injury claims, insurance coverage issues, liability and comparative fault issues, statute of limitations, and eligibility requirements.
• Working knowledge of Adobe DC and Microsoft Office Suite with expertise in Excel.
• Ability to apply and interpret Missouri statutes Chapters 537 and 287.
• Ability to evaluate medical records and expert reports.
• Ability to apply agency policies and procedures.
• Ability to provide testimony or other support to the legal process.
• Mediation training and experience.
• Ability to operate standard office equipment.
• Ability to review documents for accuracy and completeness.
• Ability to establish and maintain effective working relationships with co-workers and stakeholders.
• Ability to complete assignments accurately within specified timeframes.
• Ability to work independently and remain calm when dealing with stakeholders.
• Associate in Claims (AIC); Senior Claims Law Associate (SCLA); Associate in Risk Management (ARM).

The State of Missouri offers an excellent benefits package that includes a defined pension plan, generous amounts of leave and holiday time, and eligibility for health insurance coverage. Your total compensation is more than the dollars you receive in your paycheck. To help demonstrate the value of working for the State of Missouri, we have created an interactive Total Compensation Calculator. This tool provides a comprehensive view of benefits and more that are offered to prospective employees. The Total Compensation Calculator and other applicant resources can be found here.

Kalee Baker at [phone] or [e-mail]