JOB DESCRIPTION
Key Objectives:
The Claims Adjuster will directly handle claims for several third-party clients. This position will require the ability to analyze coverage issues, in addition to routine claim adjusting functions. Additionally, the position will involve drafting coverage letters, evaluating and frequent communication with various parties including attorneys.
Summary of Responsibilities:
- Provide claims handling on complex/latent claims in compliance with claims handling procedures, client SLA and within agreed authority levels, including accurately capturing and updating claims data/information in compliance with best practices.
- Apply knowledge and judgement to determine liability by gathering and analyzing relevant facts; utilizing applicable law, determining existence of coverage and the applicability of such coverage to claims presented.
- Work to reach a timely resolution to claims by developing case strategy, including developing a case evaluation and escalating issues as appropriate.
- Establish timely reserves and perform ongoing review throughout claims cycle within authority limit by estimating and validating value of claims.
- Negotiate settlement of claims by establishing appropriate negotiation strategy and utilizing available tools and resources; knowing when to escalate due to severity and complexity.
- Deal effectively with litigation by liaising with internal and external legal counsel; establishing litigation plan and budget; coordinating defense activities; reviewing litigation expenses and authorizing payments.
- Apply knowledge and judgement to determine appropriate reserve levels to set in respect of identified liabilities.
Qualifications/Skills:
- Accurate, reliable, with excellent attention to detail and an analytical approach.
- Production of high-quality written work product essential.
- Resilient and flexible, with the ability to adapt to work to short/changing deadlines.
- Effective and confident communicator and able to effectively and confidently manage multi-party relationship.
- Self-motivated
Education and Experience:
- Minimum of 2 years’ experience in a similar claims management role gained within the insurance industry.
- Appropriate state adjuster licensing required
- Experience in general liability claims preferred
- Degree educated ideally with insurance or legal qualifications.
Preferred Knowledge
- Strong analytical skills
- Strong verbal and written communication skills
- Strong interpersonal skills
- Ability to work independently and meet assigned deadlines
- Promptly responds to inquiries with a sense of urgency
- Ability to work in a collaborative and cooperative approach
- Ability to multi-task and effectively deal with interruptions
- Ability to follow instructions and established procedures
- Proficiency with MS Word, Excel and internet applications
- Highly attentive to details
- Able to work under pressure and execute good judgment in sensitive situations