Casualty Claims Adjuster I

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Requirements:

• Bachelor’s degree or equivalent relevant experience
• One year of casualty claims adjusting experience or related experience
• Relevant insurance designations preferred
• Good knowledge of the theory and practice of the claim function
• Good knowledge of insurance contracts, medical terminology and substantive and procedural laws
• Strong knowledge of computers and claims systems
• Ability to obtain all applicable state licenses
• Ability to adhere to high standards of professional conduct and code of ethics
• Good organizational and empathetic interpersonal skills
• Strong written and verbal communication skills
• Good investigative and problem-solving abilities
• Excellent customer service skills
• Ability to maintain confidentiality

Responsibilities:

• Reviews the claim notice, contracts, state statutes and policies to verify the appropriate coverage, deductibles, and payees
• Initiates timely contact with insureds and claimants to explain the claim process and initiate the investigation
• Obtains statements from insureds, claimants, and witnesses and documents summaries within the claims system
• Request and analyze investigative and other relevant reports, claim forms and documents when appropriate
• Documents claim activities, reserve analysis, and summaries of reports including Medicare (MSP) modules in the claim system
• Sets timely, adequate reserves in compliance with the company reserving philosophy and methodology
• Identifies, investigates, and proactively pursues opportunities for recovery including arranging of evidence preservation in legal compliance that meets custody, control, transfer, analysis, and disposition of physical and/or electronic evidence
• Adheres to all state requirements regarding regulatory compliance by sending out letters/forms containing appropriate language according to timelines
• Reviews bills, invoices and receipts for accuracy and appropriateness
• Notifies people leader of claims that may need escalation or reassignment
• Drafts reservation of rights and coverage denial letters with supervisor approval
• Assigns vehicle/property damage appraisals and vehicle rentals
• Makes recommendations to people leader on the assignment of independent adjusters
• Provides prompt, detailed responses to agents, insureds, and claimants on the status of claims
• Resolves questions of coverage, liability and the value of the claims and communicates with insureds and claimants to resolve claims in a timely manner
• Prepares bodily injury and/or damage evaluations, negotiation ranges and target settlement numbers prior to negotiation.
• Obtains authority when required
• Identifies and protects all liens as appropriate
• Investigates Medicare liens and resolves issues in accordance with EMC and Medicare guidelines
• Communicates with insureds, claimants, and attorneys to negotiate the settlement of claims
• Prepares and issues settlement and release documents verifying accuracy and ensuring they are properly executed
• Issues timely payments
• Reviews and audits estimates written by independent adjusters for accuracy and to ensure the most cost-effective repair approach
• Submits referrals to the Estimatics, Special Investigation, Subrogation, Medical Review Units and Claims Legal teams as appropriate
• Prepares risk reports for Underwriting and Risk Improvement
• Prepares claims and participates in claims roundtables to discuss unique cases to evaluate coverage and damage