Claims Adjuster

Job Title: Claims Adjuster

Job Code: 057

Grade: H

Prepared By: Shannon B. Henderson

Prepared Date: November 9, 2026

Approved By: Emily L. Stanford

Approved Date: November 9, 2026

SUMMARY

Sets up new worker’s compensation and liability claims. Analyzes insurance claims to determine extent of system's liability and/or insurance carrier's liability and settles claims with claimants in accordance with policy provisions by performing the following duties.

ESSENTIAL DUTIES AND RESPONSIBILITIES

• Receives, investigates, and processes property, casualty, liability, and workers’ compensation claims.
• Establishes claims in the appropriate claims management system or forwards documentation to the designated third-party administrator or insurance carrier.
• Collects and reviews incident reports, witness statements, medical records, photographs, and other supporting claim documentation.
• Evaluates claims, determines potential liability, assesses damages, and recommends appropriate resolutions.
• Communicates with employees, school administrators, parents, claimants, insurance carriers, and outside agencies regarding claims and required documentation.
• Processes workers’ compensation forms, injury reports, medical documentation, and other required paperwork.
• Monitors workers’ compensation claims and follows up on employee work status, medical documentation, and outstanding information.
• Negotiates settlements within established authority and refers claims for additional approval when necessary.
• Inspects district facilities, equipment, and operations to identify potential risks and follows up on identified concerns.
• Maintains accurate and confidential claim files, databases, spreadsheets, and records.
• Prepares claim summaries, statistical reports, routine correspondence, and other Risk Management documentation.
• Performs basic accounting duties, including reconciling spreadsheets, tracking claim expenses, and reviewing payment information.
• Interprets and applies district policies, safety procedures, insurance requirements, and applicable regulations.
• Works tactfully and cooperatively with district employees, administrators, schools, agencies, parents, and the public.
• Reads and interprets safety rules, operating instructions, maintenance procedures, and policy manuals.
• Communicates effectively, both verbally and in writing, and presents information to individuals and groups as needed.
• Demonstrates proficiency in Microsoft Word, Excel, claims management systems, and related technology.
• Maintains confidentiality of employee, medical, financial, and claims-related information.
• Performs other related duties as required or assigned.

QUALIFICATIONS

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

EDUCATION and/or EXPERIENCE

Bachelor's Degree; two to four years job-related experience; or equivalent combination of education and experience.

LANGUAGE SKILLS

Ability to read and interpret documents such as safety rules, operating and maintenance instructions, and procedure manuals. Ability to write routine reports and correspondence. Ability to speak effectively before various groups involved with the school district, with employees about work related accident, as well as claimants on liability claims.

REASONING ABILITY

Ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists. Ability to interpret a variety of instructions furnished in written, oral, diagram, or schedule form.

PERSONAL CHARACTERISTICS

Ability to plan, organize, and oversee daily job duties. (Must be highly self-motivated.)

Ability to communicate effectively.

Physical stamina and emotional stability to work effectively under pressure and to keep all aspects of the job under control in fast pace environment.

Ability to hold records, reports, and conversations in confidence.

PHYSICAL DEMANDS

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the employee is frequently required to sit and talk or hear. The employee is occasionally required to walk and use hands to handle or feel objects or controls.

WORK ENVIRONMENT

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the employee occasionally works in outside weather conditions and is occasionally exposed to fumes or airborne particles. The noise level in the work environment is usually moderate.

PROFESSIONAL CONDUCT

Employee acknowledges that he/she is required to maintain a high standard of professional conduct. Breach of said professional conduct includes but is not limited to: neglect of duty, dishonesty, engagement in acts that are contrary to CPSB policy, unlawful activities, or any other conduct which is seriously prejudicial to the school system.

CHAIN OF SUPERVISION

Risk Manager

CFO

TERMS OF EMPLOYMENT

260 days