Employees in this class conduct professional-level work in consumer service, licensure, claims examining, and claims adjusting work related to unemployment insurance, workers’ compensation, or other insurance administered or regulated by the state.
Employees work independently with limited supervision. Work involves both recurring duties and new assignments. Some incumbents may supervise staff.
Communicates with claimants and insured regarding coverage questions, status of claims, and other questions to ensure they have accurate and complete information. Resolves specialized work items initiated through the claims process. Reviews new claims for coverage and provides instructions on handling claims. Authorizes medical and lost time payments in accordance with the South Carolina Workers’ Compensation Law. Handles assigned claim case load. Investigates small tort and property claims by reviewing policy language and coverages and gathering necessary information to conclude claims. Investigates automobile comprehensive and collision claims by reviewing policy language and coverages and gathering necessary information to conclude claims. Logs notes detailing steps taken to resolve claims. Works with third party administrator ensuring claims are paid appropriately and within insurance policy guidelines. Reviews complex medical terminology and pertinent claim documents to independently exercise judgment in claim processing.
Knowledge of rules of quasi-judicial procedure and rules of evidence. Knowledge of insurance principles and practices. Knowledge of investigative techniques. Ability to communicate effectively both orally and in writing. Ability to prepare comprehensive reports. Ability to apply legal and administrative decisions, rulings, and principles. Knowledge of workers' compensation law, rules and regulations. Knowledge of insurance practices and procedures. Actionable knowledge of the South Carolina Tort Claims Act. Knowledge of legal processes, medical terminology, costs of medical treatment, insurance policies and coverages, costs of automobile repair and service, and value of real estate. Knowledge of methods and techniques for determining compensable wages. Knowledge of Employment Security law pertaining to unemployment insurance. Knowledge of the federal unemployment laws and their relationship to state laws. Ability to work in a team atmosphere. Ability to analyze and draw valid conclusions from documentary evidence.
A bachelor’s degree.