Adjuster handles first and third party bodily injury and assignment of property damage claims. Role focuses on claim resolution with attorney involvement and with authority of up to $12,500 handling claims in excess of this authority with manager supervision.
- Understands concepts of coverage, policy interpretation, exposure recognition and liability determination to analyze and move claims towards resolution.
- Analyzes facts of loss, injury, and possible exposure potential for proper reserving.
- Documents files to include all key activities, contacts made, statements taken, including outline covering all aspects of the claim and for resolution; Negotiates bodily injury claims with attorneys.
- Determines liability exposures for moderate impact losses to include comparative negligence issues and utilization of outside investigators or experts to assist in the review or investigation of more complex claims
- Completes material damage assignments and handles initial rental assignments
- Reviews medical records and bills to validate accuracy of services provided.
- Completes bodily injury evaluation summary including liability, damages, causation, diagnosis, treatment, reserves, and general damages; Evaluates soft tissue injuries will be primary focus.
- Utilizes expert systems to assist in the review and evaluation of claims.
- Identifies referrals, completes proper summaries and forwards files to subrogation for collection in a timely manner
- Refers files for specialization such as SIU focus, minor damage focus and sends correspondences related to claim and department of insurance regulations.
- Determines with manager assistance on investigative activities such as surveillance, or neighborhood canvasses.
- Reviews demand packages and complete evaluations in accordance with the best practices.
- Detail-oriented with strong organizational, negotiation, influential, and customer service skills, able to work well under deadlines in a changing environment and perform multiple tasks effectively and concurrently.
- Demonstrated ability to work effectively independently and within a collaborative team oriented environment using sound judgment in decision-making.
- Demonstrated ability to manage relationships with both internal and external customers.
- Excellent communication skills both oral and written with strong presentation skills.
- Strong analytical and problem solving skills.
- Demonstrated knowledge with MS Office products (Outlook, Word, Excel, PowerPoint) and claims related software applications.
- Demonstrated knowledge of medical treatments and understanding of the relationship between vehicle impact and claimed injuries.
- Demonstrated knowledge with handling minor to moderate claims involving issues of coverage.
- Demonstrated knowledge in receiving and negotiating liens with healthcare providers and worker?s compensation carriers for first and third party injury claims.
Experience / Education:
- Bachelor?s degree in Business Administration, a related field, and/or equivalent education required.
- Three to five years of claims adjuster attorney experience.