Senior Casualty Claims Adjuster
General Purpose of Position: The Senior Casualty Claims Adjuster role provides prompt, courteous, and fair claim service on bodily injury and property damage liability claims. This position is responsible for investigation of personal lines and commercial general liability claims to determine coverage, corresponding with various parties via phone and in person, completing claim evaluations, and negotiating damage settlements. This role will be documenting claim activity into our claim system and following process guidelines that provide fair settlements or claim resolutions, customer satisfaction and excellent cost management. This position will have authority to interact with team members, policyholders, and attorneys as required to complete the functions and responsibilities of the position. Attendance at selective court ordered and voluntary mediations is required.
Essential Functions and Responsibilities: The following are the usual, basic and essential functions of the position. These functions are not to be construed as an exhaustive list of all responsibilities, duties, and skills required.
- Acknowledge claim assignments; confirm policy coverage, direct adjustment of claims.
- Interpret policy, make decisions using independent judgment on moderate-to-difficult claims and determine if coverage applies to claims submitted.
- Investigate claims to determine validity and verify factual elements, which may include the securing of Recorded Statements, necessary to properly evaluate liability and damages.
- Negotiate settlements and authorize payments within scope of authority, settling claims timely, and in the most cost-effective manner.
- Investigate and settle advanced, large loss, complex claims promptly and amicably.
- Report pertinent information regarding injury claims involving possible Medicare benefits per the Medicare/Medicaid – Section 111 guidelines.
- Complete Bodily Injury Evaluation Reports per guidelines on all bodily injury claims.
- Employ effective litigation management techniques in the appropriate venue.
- Develop and maintain working relationships with approved vendors/experts.
- Keep abreast of claim and related legal principles, as well as underwriting rules and procedures.
- Effectively prepare Declination, Reservation of Rights letters, Excess Liability letters and other claim specific letters as applicable.
- Understanding and application of applying appropriate reserves on assigned claims.
- Ensures that all assigned claims are concluded promptly and equitably.
- Promote a culture of personal responsibility, open communications, and continuous improvement.
- Ensure fair and ethical policies and practices in all relationships and operations.
- Exhibits leadership experience and skills.
- Exceptional problem-solving ability.
To perform this job successfully, an individual must be able to perform each essential function and responsibility satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential job functions.
- Bachelor's degree or equivalent combination of relevant education and experience.
- Minimum 5 years experience adjusting moderate to complex claims with increasing responsibilities in a company environment.
- As required by regulatory entities, relevant professional designations, and certifications highly desirable. Ability to acquire insurance licenses as required by role. Florida License in good standing is required; and ability to acquire South Carolina, Louisiana, and Texas Property & Casualty Insurance Adjuster License within 60 days of hire
- Communicates verbally and through written reports, memoranda with insureds, claimants, attorneys, and other individuals, as needed.
- Possesses the ability to professionally articulate a position or a decision in an adversarial situation.
- Strong computer skills (i.e. Word, Excel, Access, Outlook, Web based programs)
- Experience using Claim systems.
- Ability to understand the long-term and short-term perspectives of situations.
- Ability to manage relationships in a fast-paced environment, while demonstrating persistence and problem-solving skills
- Desirable skills include, but not limited to: Interpersonal and leadership skills, collaboration, facilitation, negotiation skills, self-awareness, confidence, ability to manage conflict and empathy.
- Completion of Continuing Insurance Education, not limited to IIA, AIC, CPCU and/or Risk Management
- Bilingual encouraged to apply
Certificates or Licenses:
As required by regulatory entities. Relevant professional designations or skill certifications are desirable.