[Close] 

Senior Casualty Claims Adjuster

The role of the Senior Casualty Claims Adjuster is to investigate, evaluate and adjust Commercial General and Automobile Liability claims. Assigned claims typically consists of medium to complex non-litigated and litigated general liability and third party automobile bodily injury and property damage claims, and may include claims involving more specialized lines of business such as employment practices liability, construction defect, and errors, and omissions. Must also be able to handle more complex, litigated claims.
Evaluate insurance coverage based on claim report, the insurance policy, applicable statutes and case law to determine if a claim can be accepted as within coverage.
Comply with all statutory and regulatory requirements in all applicable jurisdictions.
Obtain and review medical records.
Interview, telephone, and/or correspond with claimant and witnesses; obtains and reviews police hospital records, appraisals and repair estimates to evaluate injuries property damage; Reports to client as required by contractual account instructions; varying method of investigation according to type of coverage
Identify key issues and investigation required.
Meet detailed quality assurance standards of performance
Obtain and maintain all required licenses and certifications and meet all continuous training and certification requirements.
Determine extent of the client's financial exposure with respect to claims; set case reserves for use by clients and regulatory authorities
Revise case reserves based on developments in the course of adjusting the claim
Settle claims within assigned levels of authority as set forth in complex, detailed client account instructions
Handle complex litigated claims with limited input from the Unit Manager and/or AVP
Effectuate prompt payment (with client's funds) to claimants and service providers
Select and manage defense and coverage counsel
Select and manage experts
Work with and provide claim-specific guidance to Field Adjusters
Be alert to insurance fraud and implement special procedures if fraud is suspected.
Involve client in decision-making as appropriate and/or follow client-specific requirements for escalation when client decision-making and/or notification is required.
Interact successfully with co-workers
Other duties as assigned

Required Skills

SKILLS/ABILITIES
Excellent negotiation skills
Engage and manage coverage counsel and defense counsel
Review and analyze medical records
Review and analyze expert's reports
Excellent oral and written communication and presentation skills
Analytical and interpretive skills
Strong organizational skills
Solid interpersonal skills
Strong customer service skills
Able to multitask
Capable of setting priorities
Works well under pressure
Spanish fluency is a plus
KNOWLEDGE:
In-depth knowledge of multi-jurisdictional claims handling issues
PC literate, including Microsoft Office products
Required Experience
EDUCATION:
Bachelor's degree in related field from four-year college or university preferred
Experience:
Extensive knowledge of investigation management including, but not limited to, taking and using recorded statements, determining coverage and application of coverage to claims, delivering case value and negotiation and resolution of claims.
Minimum of 5 + years of industry experience in Property and Casualty

Don't Be Fooled

The fraudster will send a check to the victim who has accepted a job. The check can be for multiple reasons such as signing bonus, supplies, etc. The victim will be instructed to deposit the check and use the money for any of these reasons and then instructed to send the remaining funds to the fraudster. The check will bounce and the victim is left responsible.