Bernalillo County

DUTIES AND RESPONSIBILITIES

• Supervises Claims Section personnel responsible for gathering documentation, evaluating coverage and liability, and resolving claims.
• Ensures staff obtains necessary documents, forms, and photos to support claims.
• Oversees evaluation of policy coverage, liability, damages, and exercises sound judgment in determining final claim disposition.
• Ensures timely completion of vendor appraisals to assess claim-related damages.
• Closely monitors property and casualty claims exceeding the deductible, adjusted by third-party administrators.
• Investigates questionable claims and audit for potential overpayments or irregularities.
• Develops policies, procedures, and workflows for handling internal claims under the self-insured retention and those handled by third-party administrators.
• Maintains and updates the Risk Management Claims Manual; ensures confidentiality and best practices.
• Works towards timely resolution and closure of claims in alignment with departmental standards.
• Pursues and manages subrogation and recovery when applicable.
• Monitors the performance of third-party administrators and contractors to ensure compliance with County interests and contract terms.
• Coordinates with third-party administrators, County Legal, external counsel, and departments on tort claim defense.
• Reviews and analyzes evidence presented by departments to support tort defense.
• Participates in RFB and RFP evaluations for relevant services such as auto repair, medical services, and glass replacement.
• Analyzes claims data and reports to recommend risk reduction strategies.
• Participates in mediations, hearings, and Workers’ Compensation Administration proceedings.
• Plans and leads regular claim review meetings with insurance providers and departments.
• Represents the department in meetings, trainings, and committees; create and deliver presentations.
• Serves as the department’s Local Custodian of Public Records (LCPR); manages claim record archiving in compliance with state statutes and County records policy.
• Proposes and monitors Claims Section budgets, including deductible expenses, premiums, and subrogation revenues.
• Reviews quotes, purchase orders, and invoices for accuracy and supporting documentation.
• Audits vendor and third-party administrator invoices to ensure consistency with quotes and coverage terms.
• Conducts thorough investigations of reported claims, including potential fraud.
• Provides customer service to internal and external stakeholders by phone and in writing regarding claims inquiries.
• Ensures compliance with all applicable federal, state, and local laws related to claims administration.

*The above information is intended to outline the general nature and scope of the duties required for this position. It is not an exhaustive list and may vary depending on specific job assignments and responsibilities. 
 

MINIMUM QUALIFICATIONS

• Bachelor’s degree in Business Administration, Paralegal Studies, Pre-Law, or related field.
• Six (6) years of work experience in adjusting worker’s compensation, property and casualty claims, risk management principles, NM Worker’s Compensation Law.
• Two (2) years in a supervisory role.

*Any equivalent combination of related education and/or experience may be considered for the above requirements. 


SUPPLEMENTAL INFORMATION

SCREENING AND COMPLIANCE

• Successfully complete the County’s post-offer medical examination.
• Comply with all County safety guidelines.
• Possess and maintain a valid New Mexico driver’s license.
• Complete required FEMA training(s) assigned to the position.
• Complete required supervisor training, if applicable.

WORKING CONDITIONS

• Essential duties are primarily performed indoors in a climate-controlled environment.
• Primary work surfaces are even and dry, typically carpeted or tiled.
• Work is performed both independently—with or without direct supervision—and occasionally as part of a team or work group.

EQUIPMENT, TOOLS, AND MATERIALS

• Equipment used includes a computer, telephone, calculator, facsimile machine, photocopier, camera, and recording equipment.
• Materials and products handled include logs, spreadsheets, graphs, charts, writing utensils, safety manuals, rules and regulations, and various office forms.