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WI Waukesha Office
R2417 Casualty Claim Adjuster I (Open)
The Casualty Claim Desk Adjuster position supports the Claim Division goal of ensuring customer service industry leadership and partners with agency to deliver seamless claim service. An experienced adjuster who can work with on moderately complex casualty desk claims that primarily do not require on-site inspection or face-to-face contact. Performs with a high degree of competency and continues to develop a mastery of skills and insurance knowledge required of an experienced claim adjuster. Facilitates continuous development of people, processes, and culture to ensure customer service industry leadership.
*Handling both investigation and injury aspects of casualty losses
*Will require parties to become licensed in states where this applies
*The candidate may be hired at the Casualty Claims Adjuster II level depending on experience.
*Offer to selected candidate will be made contingent on the results of applicable background checks.
*Relocation assistance is available
Analyzing and Evaluating Factual Evidence (20%)
- Compiles, analyzes, and evaluates factual information to formulate an opinion on more difficult liability claim losses. Recognizes economical, legal, and practical consequences of decisions.
- Evaluates minor to major property damage liability losses, including loss of use and related expenses.
- Evaluates moderate to severe injury claims value based on permanency, nature of injury, disability and scarring, lost income and medical bills.
- Understands and applies applicable case law and statutes, considering geographic location and local ordinances.
- Evaluates current and prior medical history/problems.
- Recognizes potentially fraudulent activities, utilizes SIU, Medical Services, and other sources, as needed.
- Utilizes electronic tools for injury evaluation.
File Management (15%)
- Actively manages individual claim inventory and works toward meeting cycle-time goals for closing files. Claim inventory will focus on moderately complex claims that can be primarily handled without on-site inspection and face-to-face customer interaction.
- Utilizes the electronic integrated claim system to complete and document actions throughout the life of the file.
- Conducts initial review of claims received to identify prior actions taken (e.g. services provided by the Customer Care Center and appointments scheduled) and determine next steps.
- Contributes to the team environment by assisting with claims from other adjusters` inventories in their absence. Responds to customer inquiries, makes appropriate decisions and closes file as needed.
- Makes independent decisions and self-supervises most files but recognizes when assistance is needed.
Securing Factual Evidence (15%)
- Secures physical damage estimates utilizing our Physical Damage personnel or independent facilities; applies working knowledge of repair procedures to determine if damages are accident/incident related.
- Secures medical bills and reports and verifies lost income and expenses on complex medical issues.
- Demonstrates a thorough knowledge of when to secure prior claim history from physical damage, injury and frequency, and consults with appropriate technical personnel on more complex issues.
- Recognizes and interprets primarily Auto, Homeowner, Boat, and Motorcycle policies. Will also handle Umbrella policies.
- Analyzes loss report, secures official reports and determines proper course of action.
- Obtains specific photographs and measurements, and other evidence as needed.
- Investigates cause and origin of claim by contacting the appropriate parties.
- Identifies complex issues and seeks assistance as needed.
- Recognizes when to secure public documents to complete a claim file investigation. Secures, preserves and maintains evidence in a legal manner
- Recognizes and investigates losses involving subrogation and contribution potential. Has knowledge of third party and tort liability.
- Discusses loss with all parties, obtains statements on complex losses involving all applicable policies by applying a thorough knowledge of written and recorded statement techniques.
Negotiation, Settlement (15%)
- Handles claim negotiations by settling and providing the best customer experience in the industry.
- Provides a clear explanation of the estimate to the customer, answers all questions and processes the claim payment.
- Recognizes the need for and obtains non-waiver as needed. Recognizes the need for and sends reservation of rights letters.
- Recognizes, controls and resolves disputes with tact and diplomacy. Notifies or directly involves the agent in the dispute resolution. Utilizes arbitration, appraisal and alternate dispute resolution as needed. Recognizes the need and obtains necessary assistance.
- Utilizes severity controls, including structured settlements, early contact settlements, open-end releases, mediation, arbitration, and other alternate dispute resolution methods.
Agency Relationship (10%)
- Establishes rapport with agents and builds on-going relationships by including agents in the claim handling process as appropriate.
- Partners with agency to provide seamless customer service.
- Facilitates communication between customers, agents, vendors, third party administrators and other employees. Proactively 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 agents in problem resolution as appropriate.
- Provides agents with claim handling information via phone conversations and written correspondence.
Policy Determination & Analysis (10%)
- Interprets and determines state-specific differences in policies and contract coverages and applies to all parties for assigned losses. Interprets claim history coverages. Selects proper loss codes based on policy type.
- Identifies state-specific legislation and legal precedent based on prior legal cases for assigned geographic area. Seeks assistance as needed.
- Utilizes company claim bulletins, manuals and best practices. Demonstrates knowledge of underwriting guidelines, inspects risks and makes recommendations to the Underwriting Department as needed.
- Applies decision making process to available data to determine extent of coverage or non-coverage and communicates results to appropriate parties.
Specialized Knowledge and Skills Requirements
- Must be willing to travel for Catastrophe duty if necessary.
- This position requires travel up to 10% of the time.
- Demonstrated experience providing customer-driven solutions, support or service
- Demonstrated ability to efficiently and effectively handle simple to moderately complex casualty claims.
- Demonstrated fundamental understanding of policies and endorsements related to casualty coverages.
- Successfully applied knowledge of each phase of the casualty claim handling process.
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