Casualty Claims Adjuster I

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

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