Employees in this class conduct complex 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 may involve more complex assignments. Some incumbents may supervise staff.
Provides ongoing technical assistance to internal and external stakeholders associated with specialized aspects of the Unemployment Insurance (UI) claims process. Audits employer records. Conducts separation and non-separation fact finding interviews for unemployment insurance claims in accordance with UI Operations policies and guidelines, while adhering to Benefit Timeliness and Quality (BTQ) standards. Issues determinations in accordance with Benefit Timeliness Quality (BTQ) standards, SC Code of Laws, SC Regulations, and UI Division policy and guidelines. Obtains professional medical opinions and medical records for insured in investigating claims. Establishes loss and expense reserves. Adjusts initial reserves to convey the value of the injury. Negotiates the settlement using oral and written communication. Communicates with claimants and insured regarding coverage questions, status of claims, and other questions to ensure they have accurate and complete information. Examines and evaluates governmental claims for liability and property losses. Supervises the activities of independent contracted claims adjusters. Attends mediations of litigated claims on behalf of insured. Manages underwriting, processing of applications, renewals, and endorsements. Prepares quotes and answers coverage questions. Reviews appraisal values.
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 and relevant experience.