Casualty Claims Adjuster I

Essential Functions:

• 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

Education & Experience:

• Bachelor’s degree or equivalent relevant experience

• One year of casualty claims adjusting experience or related experience

• Relevant insurance designations preferred

Knowledge, Skills & Abilities:

• 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

• Occasional travel required; a valid driver’s license with an acceptable motor vehicle report per company standards required if traveling