The primary responsibilities will include the investigation, evaluation, negotiation and resolution of assigned liability claims having high complexity and value, working within delegated reserve and settlement authority. With high degree of independence, handles highly complex claims related to unique coverage and/or exposure issues. Is considered a Subject Matter Expert with the department. Serves a trainer for other peers.
Essential Duties and Responsibilities:
Investigates, evaluates, negotiates and resolves assigned liability claims of high complexity.
Determines the facts of the loss, coverage compensability and the degree of exposure by unit of coverage.
Reviews, analyzes, and applies policy conditions, provisions, exclusions and endorsements pertinent to a variety of losses.
Establishes timely and accurate liability claim and expense reserves.
Communicates clearly and professionally with the customer, or their representative, by telephone and/or write correspondence regarding all aspects of the claims process.
Serves as Subject Matter Expert on the liability claims process, by identifying and suggesting process improvement ideas to increase efficiency in the claim process.
Leads and participates in complex projects in coordination with the Unit Managers.
Trains and certifies the senior resolutions level; develops the training material for the functional claims training.
Determines settlement amounts based on independent judgment, estimation of actual cash value and replacement value, contractor estimate validation, appraisals, application of applicable limits and deductibles.
Negotiates and conveys liability claim settlements within authority limits to insureds.
Controls damage exposures through proper usage of cost containment tools.
Maintains an effective diary system to ensure timely resolution and document claim file activities in accordance with established procedures and state regulations.
Provides excellent customer service to meet the needs of the insured, agent and all other internal and external customers.
Works with attorney at all levels (pre litigation) in resolving disputed claim.
Directs defense attorneys through the litigation process in accordance with corporate objectives.
Works collaboratively with all departments and external customers, including TPA's and other claim vendors.
Partners with counsels to develop litigation plan and adhere to applicable guidelines.
Successfully completes training sessions to remain current with industry trends and changes.
Performs other duties as required.
This job description has been prepared to indicate the general nature and level of the work that the employees perform within their classification. This description is not and cannot be interpreted as an inventory of all the duties, tasks, responsibilities and qualifications required for the employees assigned to this job.
Education and/or Experience:
Bachelor's Degree preferred but not required
Minimum of ten (10) years of progressive experience in the adjusting of residential and commercial claims or a combination of education and experience.
Strong verbal and written communications skills.
Must be able to work in a collaborative atmosphere.
Must be proficient with Microsoft Office, including Word, Excel, and PowerPoint.
Customer service orientation; empathy.
Demonstrate ownership attitude and customer centric response to all assigned tasks.
Solid analytical and decision making skills.
Excellent negotiation skills.
Hardware and software skills to utilize and leverage claim and estimating technology.
Bilingual a plus.
AIC a plus.
Professional designation specific to claims a plus.
Licenses and / or Certifications:
Adjuster's license(s) (where applicable) required or successfully acquired within 60 days of hiring.