Sr. Claims Adjuster - Liability
*Remote opportunities available
Ensures claims are fairly and accurately investigated and evaluated in accordance with established timelines, customer service standards, and quality standards. Responsible for assessing coverage, completing a thorough liability and damage analysis of complex third-party bodily injury and property damage claims and effectively negotiating settlements fairly and equitably with all parties. Offers a high level of professionalism and expertise for the department's benefit. A Sr. Liability Claims Adjuster will demonstrate proficiency in handling bodily injury and property damage claims, attorney represented files and large losses.
Essential Job Functions
- Determines insurance coverage.
- Examines and appropriately interprets insureds' policies, forms in force, and other records.
- Identifies other available excess or concurrent coverage.
- Demonstrates a clear understanding of policy provisions related to the insuring agreement, exclusions and endorsements which affect coverage.
- Investigates all relevant facts needed to evaluate coverage, liability, and damages on casualty claim files that involve complex issues, severe injuries and/or multiple parties.
- Determines extent of insured's liability.
- Interviews, telephones, or corresponds with insureds, claimants, attorneys and witnesses.
- Uses varying methods of investigation, including taking recorded statements, consulting with police, inspecting property damage, and reviewing documents.
- Understands and applies applicable state laws on negligence and liability.
- Sets cases for pre-suit mediations or hearings where appropriate.
- Possesses a comprehensive understanding of medical terminology and procedures.
- Evaluates and determines injury/damage causality to the loss taking into account prior or subsequent occurrences and pre-existing injuries.
- Responds to demands, decisions, agreements, and/or court orders; creates action plan; determines need for peer review and CME.
- Negotiates claim settlements within authority limits
- Establishes appropriate initial case reserves; reviews and revises case reserves on assigned files to allow for probable costs.
- Submits assignments to vendors as appropriate.
- Effectively manages pending file s diaries and tasks in the Claims System.
- Prepares report of findings and negotiates settlement.
- Prepares settlement letters, denial letters, Reservation of Rights, and other letters as needed.
- Writes clear and concise diary notes, uses the Special Handling area, sets field assignments, sets and saves contacts, and makes payments.
- Recognizes the need for SIU involvement and flags files for potential subrogation.
- Appropriately applies knowledge of multiple state statutes, including the insurance code of ethics, rules, regulations and guidelines.
- Effectively handles and responds to calls from customers, vendors, and others.
- Presents claims in a concise, but comprehensive manner at monthly brainstorm meetings.
- Performs other duties as assigned.
- Motivation to lead an adjuster's life.
- Willingness to work flexible shifts, 7 days per week with 12-hour shifts for major catastrophes, and overtime as needed for claim spikes.
- Ability to grasp concepts quickly, pay attention to details, think through problems logically, apply high-school-level math skills, and make appropriate decisions.
- Demonstrates integrity.
- Possesses strong English vocabulary, basic grammar skills, and professional decorum. Writing is clear and easy-to-read. Bi-lingual skills helpful.
- Strong organizational skills and the ability to multi-task in a fast-paced environment.
- Demonstrates active listening skills through effective use of questions, reflection, and empathy.
- Demonstrates a bias toward exceptional customer service; experience providing customer service preferred.
- Possesses strengths in negotiation.
- Demonstrates the ability to get along with work associates.
- Proficiency in Microsoft Word required. Proficiency in Excel preferred.
- General knowledge of insurance and adjusting.
- Bachelor's degree or higher; four years of prior work experience within claims, financial services, customer service, construction, property management, medical or related field; or some combination thereof.
- Minimum three years of casualty claims experience required.
- Property and casualty experience helpful.
- Adjuster 620 License required in applicable states.
Benefits & Perks:
As an employee, you will enjoy an inclusive environment that embraces strategic thinking, drive and passion. As a company committed to our employees, its not surprising that we offer great benefits that include:
- Paid training, tuition assistance and career development.
- Diverse, welcoming culture.
- Casual dress (yes, you can wear jeans to work!)
- Medical, dental, vision, paid time off and a 401K plan that is 100% vested!