STATE OF NEW HAMPSHIRE
CLASSIFICATION: CLAIMS AND HEARINGS OFFICER
Class Code: 2027-26 Date Established: 06-22-72
Occupational Code: 7-5-5 Date of Last Revision: 12-28-01
BASIC PURPOSE: To conduct appeal hearings and render decisions in accordance with pertinent insurance laws and policies.
CHARACTERISTIC DUTIES AND RESPONSIBILITIES:
· Determines need for formal hearings, makes arrangements for hearings and issues necessary notifications to all parties and witnesses.
· Prepares necessary data and presides at quasi-judicial hearings on appeals filed by recipient, claimants or participants.
· Confirms or negates previous action taken in suspension of license or benefits and makes determinations based upon information presented.
· Makes decisions based upon relevant facts, findings and federal and state laws; prepares appropriate reports.
· Issues written decisions and other relevant information to hearing participants and appropriate staff members.
Skill: Requires skill in analyzing and interpreting data, policy and procedures OR in using equipment in order to arrive at logical conclusions or recommendations.
Knowledge: Requires logical or scientific understanding to analyze problems of a specialized or professional nature in a particular field.
Impact: Requires responsibility for achieving major aspects of long-range agency objectives by planning short- and long-term organization goals, reviewing recommendations for procedural changes, and developing or revising program policies. Errors at this level result in incorrect decisions at an administrative level, and are detected subsequent to implementation in an overall evaluation process.
Supervision: Requires partial supervision of other employees doing work which is related or similar to the supervisor, including assigning job duties, providing training, giving instructions and checking work.
Working Conditions: Requires performing regular job functions in a controlled environment with minimal exposure to disagreeable job elements and little risk of hazard to physical or mental health.
Physical Demands: Requires light work, including continuous walking or operating simple equipment for extended periods of time as well as occasional strenuous activities such as reaching or bending.
Communication: Requires acting as the official representative of the agency, including explaining and defending current and long-range goals or objectives which directly affect public policy decisions regarding major state programs and services.
Complexity: Requires evaluating a combination of wide-ranging job functions to determine work procedures, to solve problems, and to reach conclusions by applying analytical, technical, or scientific thinking. This level also requires planning policies and long-term strategies, drawing conclusions based on available criteria, and evaluating the effectiveness of program objectives.
Independent Action: Requires independent judgment in planning and evaluating work procedures and in supervising the development of professional, technical and managerial standards under administrative direction and according to broad departmental guidelines.
Education: Bachelor's degree from a recognized college or university with major study in business administration or accounting. Each additional year of approved formal education may be substituted for one year of required work experience.
Experience: Five years' experience in the claims department of an insurance company, adjusting firm or an insurance department directly dealing with claimants to negotiate settlements under the various forms of coverage in fire, liability, casualty, including accident and health and life insurance. Each additional year of approved work experience may be substituted for one year of required formal education.
License/Certification: None required.
RECOMMENDED WORK TRAITS: Knowledge of insurance principles and practices. Knowledge of the scope, content and process of the state regulations and laws relating to insurance. Knowledge of the methods and techniques of field investigation. Knowledge of insurance terminology and the relationship pertaining to the contractual provisions of insurance policies and the payment of claims. Ability to gather information through personal interview of records, correspondence and documents. Ability to objectively evaluate information received and to make sound recommendations. Ability to express ideas clearly and concisely. Ability to maintain effective working relationships with complainants, insurance industry representatives and the general public. Ability to resolve complicated questions of liability and amounts of damages. Must be willing to maintain appearance appropriate to assigned duties and responsibilities as determined by the agency appointing authority.
DISCLAIMER STATEMENT: This class specification is descriptive of general duties and is not intended to list every specific function of this class title.
Last Updated 05/10/02