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.
• Relevant insurance designations preferred.
• Strong knowledge of the theory and practice of the claim function.
• Strong knowledge of insurance contracts, medical terminology, and laws.
• Strong proficiency in computers and claims systems.
• 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 claim notice, contracts, state statutes, and policies for coverage verification.
• Initiates timely contact with insureds and claimants to explain the claim process.
• Obtains statements from parties involved and documents summaries in the claims system.
• Requests and analyzes investigative reports, claim forms, and relevant documents.
• Documents claim activities and sets reserves according to company methodology.
• Identifies recovery opportunities and maintains legal compliance.
• Handles litigated files of low complexity and recommends defense counsel when needed.
• Manages vendor assignments and verifies accuracy of legal expenses.
• Communicates status of claims to stakeholders and resolves coverage issues.
• Prepares evaluations, negotiation ranges, and settlement numbers.
• Investigates and resolves Medicare liens according to guidelines.
• Negotiates settlements and assists with suits, mediations, and arbitrations.
• Prepares settlement documents and issues timely payments.
• Reviews estimates for cost-effectiveness and submits referrals as appropriate.
• Participates in claims discussions and assists team members.
• Trains and serves as a technical resource for team members.