Casualty Claims Adjuster II

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Requirements:

• Bachelor’s degree or equivalent relevant experience.
• Three years of casualty claims adjusting experience or related experience.
• Strong knowledge of the claim function theory and practice.
• Strong knowledge of insurance contracts and medical terminology.
• Strong computer and claims system knowledge.
• Ability to obtain applicable state licenses.
• Good organizational and interpersonal skills.
• Strong written and verbal communication skills.
• Strong investigative and problem-solving abilities.
• Excellent customer service skills.
• Ability to maintain confidentiality.

Responsibilities:

• Promptly investigates and evaluates moderately complex auto and casualty claims.
• Reviews claims to verify coverage, deductibles, and payees.
• Initiates contact with insureds and claimants to explain the claim process.
• Obtains and documents statements from involved parties.
• Requests and analyzes reports and documents relevant to the claims.
• Sets reserves and identifies opportunities for recovery.
• Handles litigated files of low complexity and manages vendors.
• Drafts coverage denial letters and responds to parties regarding claims.
• Prepares evaluations and negotiates settlements.
• Investigates Medicare liens and communicates with parties for settlement.
• Prepares settlement documents and ensures timely payments and accuracy of expenses.