STATE OF NEW HAMPSHIRE
HUMAN RESOURCES
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.
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DISTINGUISHING FACTORS:
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.
MINIMUM QUALIFICATIONS:
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.
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Last Updated 05/10/02
URL: /hr/classspec_c/2027.htm