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Casualty Claim Adjuster II

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Quick Stats:


CO Denver-West Regional Office

Job ID:

R1937 Casualty Claim Adjuster II (Evergreen) (Open)


The Casualty Claim Adjuster II primarily handles injury casualty claims of moderate to severe complexity that may include, but are not limited to, underinsured motorist, fatalities, and mediation/litigation management. May handle claims that involve medical payments and/or Personal Injury Protection (PIP). Continues to build a mastery of skills and insurance knowledge required of this position. Facilitates the continuous development of others. Supports the division goal of ensuring industry-leading customer service and works with business partners to deliver seamless claim service.
Job Description:

Primary Accountabilities
Securing Factual Evidence and Investigation (25%)

  • Recognizes and interprets primarily Auto, Homeowner, Specialty and Recreational policies. Will also handle Umbrella policies.
  • Reviews loss report and any prior action taken on the file to determine next steps.
  • Recognizes the need for and obtains non-waiver as needed. Recognizes the need for and sends reservation of rights letters.
  • Secures, preserves, and maintains all evidence necessary (official reports, photographs, measurements, etc.) to complete a thorough claim investigation and determine the proper course of action.
  • Secure statements and communicates with all parties as needed to obtain information in order to determine proximate cause of loss.
  • Secures medical bills and reports and verifies lost income and expenses on injury claims.
  • Identifies, investigates, and evaluates subrogation and contribution opportunities.
  • Consults with appropriate personnel on more complex issues.

Analyzing and Evaluating Factual Evidence (25%)

  • Analyzes and evaluates factual information including current and/or prior medical and wage loss documentation to determine the proper coverage, liability, and damages on injury claims.
  • Identifies state-specific differences in policies and contract coverages and applies to all parties for assigned losses. Reviews state-specific legislation and legal precedent based on prior legal cases for assigned geographic area. Understands and applies applicable case law and statutes, considering geographic location and local ordinances.
  • Interprets claim history coverages. Selects proper loss codes based on policy type. Recognizes economical, legal, and practical consequences of decisions.
  • Utilizes company claim bulletins, manuals and best practices. Demonstrates knowledge of underwriting guidelines, evaluates risks and makes recommendations to the Underwriting Department as needed.
  • Recognizes potentially fraudulent claims, utilizes SIU and other sources as needed, and consults with management.

Negotiation, Settlement (20%)

  • Negotiates and settles claims in accordance with divisional expectations. May handle litigated files.
  • Handles claim negotiations by providing a clear explanation of the coverage, liability, and settlement decision to the customer, answering all questions and processing the claim payment.
  • Recognizes, controls and resolves disputes. Utilizes structured settlements, open-end release, mediation, arbitration, appraisal and alternate dispute resolution as needed.
  • Reviews available data to determine extent of coverage or non-coverage and communicates results to appropriate parties.

File Management (15%)

  • Manages individual claim inventory and collaborates with peers to achieve unit and branch results.
  • Utilizes the electronic integrated claim system and other technologies to complete and document actions throughout the life of the file.
  • Contributes to the team environment by assisting with claims from other adjusters` inventories in their absence.
  • Works with customers, responds to inquiries, makes appropriate decisions, and closes file as appropriate.

Business Partner Relationships (10%)

  • Establishes rapport with business partners (agency, personal lines, legal, medical services, etc.) and builds ongoing relationships by including stakeholders in the claim handling process as appropriate.
  • Partners with others to provide seamless customer service.
  • Facilitates communication between customers, agents, vendors, third party administrators and other employees. Provides agents with important claim related information; provides all parties with claim process and status as appropriate; answers questions or redirects to other areas.
  • Explains and discusses any circumstances that may affect customer service with agency, vendors, third party administrators or other claim personnel. Includes others in problem resolution as appropriate.


Travel Requirements
  • Must be willing to travel for Catastrophe duty if necessary.
  • This position requires travel up to 10% of the time.
Specialized Knowledge and Skills Requirements
  • Demonstrated experience providing customer-driven solutions, support or service
  • Demonstrated experience handling casualty claims of moderate complexity (e.g., liability, coverage questions, or medical payments).
  • Solid knowledge and understanding of policies and endorsements related to casualty coverage.
  • Solid knowledge and understanding of each phase of the casualty claim handling process.

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