Adjuster, Senior Casualty Claims
- Career Level
- Not Specified
York Risk Services Group is a premier provider of insurance, risk management, alternative risk, pool administration and claims management solutions to clients across hundreds of industries. Recently named by Forbes as one of "America's Best Midsized Companies 2017" We firmly believe that our employees drive the success of the company. With success in mind as the ultimate goal, we strive to create and provide an environment that offers challenging, stimulating and financially rewarding opportunities.
The role of the Senior Casualty Claims Adjuster is to investigate, evaluate and adjust Commercial General and Automobile Liability claims. Assigned claims typically consists of medium to complex non-litigated and litigated general liability and third party automobile bodily injury and property damage claims, and may include claims involving more specialized lines of business such as employment practices liability, construction defect, and errors, and omissions. Must also be able to handle more complex, litigated claims.
ESSENTIAL JOB RESPONSIBILITIES:
- Evaluate insurance coverage based on claim report, the insurance policy, applicable statutes and case law to determine if a claim can be accepted as within coverage.
- Comply with all statutory and regulatory requirements in all applicable jurisdictions.
- Obtain and review medical records.
- Interview, telephone, and/or correspond with claimant and witnesses; obtains and reviews police hospital records, appraisals and repair estimates to evaluate injuries property damage; Reports to client as required by contractual account instructions; varying method of investigation according to type of coverage
- Identify key issues and investigation required.
- Meet detailed quality assurance standards of performance
- Obtain and maintain all required licenses and certifications and meet all continuous training and certification requirements.
- Determine extent of the clients financial exposure with respect to claims; set case reserves for use by clients and regulatory authorities
- Revise case reserves based on developments in the course of adjusting the claim
- Settle claims within assigned levels of authority as set forth in complex, detailed client account instructions
- Handle complex litigated claims with limited input from the Unit Manager and/or AVP
- Effectuate prompt payment (with clients funds) to claimants and service providers
- Select and manage defense and coverage counsel
- Select and manage experts
- Work with and provide claim-specific guidance to Field Adjusters
- Be alert to insurance fraud and implement special procedures if fraud is suspected.
- Involve client in decision-making as appropriate and/or follow client-specific requirements for escalation when client decision-making and/or notification is required.
- Interact successfully with co-workers
- Strong proficiency in keyboarding and data entry skills; most time spent in front of a computer entering text with applications.
- Must be able to type accurately, enter information into a computerized system
- Other duties as assigned
- This position reports to Unit Manager
- Directs and plans the work of staff members and has direct involvement with and/or responsibility for the hiring, coaching, developing, training, appraising and disciplinary processes for subordinates
- Bachelors degree in related field from four-year college or university preferred
- Extensive knowledge of investigation management including, but not limited to, taking and using recorded statements, determining coverage and application of coverage to claims, delivering case value and negotiation and resolution of claims.
- Minimum of 10 + years of industry experience in Property and Casualty Claims
- Excellent negotiation skills
- Engage and manage coverage counsel and defense counsel
- Review and analyze medical records
- Review and analyze experts reports
- Excellent oral and written communication and presentation skills
- Analytical and interpretive skills
- Strong organizational skills
- Solid interpersonal skills
- Strong customer service skills
- Able to multitask
- Capable of setting priorities
- Works well under pressure
- Spanish fluency is a plus
- In-depth knowledge of multi-jurisdictional claims handling issues
- PC literate, including Microsoft Office products