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Job Description

JOB SUMMARY:

The role of the Casualty Claims Adjuster is to investigate, evaluate and adjust Commercial General and Automobile Liability claims. Although assigned claims generally consist of low to medium exposure, first and third party automobile bodily injury and property damage claims, as well as premises liability accidents, professional liability claims, the casualty claims adjuster must be qualified legally and technically to handle all claims competently.

ESSENTIAL JOB RESPONSIBILITIES:

• Evaluate insurance coverage based on claim report, the insurance policy and applicable statutes and case law to determine if a claim can be accepted as being within coverage.
• Interviews, telephones, and/or corresponds with claimant and witnesses; obtains and reviews police reports, hospital records, appraisals and repair estimates to evaluate injuries and property damage; Reports to client as required by contractual account instructions; utilize appropriate methods of investigation according to type of coverage
• Obtain, review and evaluate medical records.
• Identify key coverage, damage and liability issues and plan investigation as required in accordance with contractual obligations and prevailing professional standards.
• Comply with all statutory and regulatory requirements of all applicable jurisdictions.
• Meet detailed quality assurance standards of performance
• Obtain and keep in effect all required licenses and certifications and meet all continuing training and certification requirements.
• Determine extent of the clients financial exposure with respect to claims; set case reserves for use by clients and applicable regulatory authorities
• Revise case reserves based on developments in the course of adjusting the claims
• Be alert to insurance fraud and implement special procedures if possible fraud is detected.
• Settle claims within assigned levels of authority as set forth in client account instructions
• Select and manage experts with limited input from supervisor
• Work with and provide claim-specific guidance to Field Adjuster.
• 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
• Other duties as assigned

SUPERVISORY RESPONSIBILITIES:

SUPERVISION RECEIVED:

• This position reports to the Unit Manager

QUALIFICATIONS:

EDUCATION:

• BS / BA or Equivalent Work Experience
• Licenses as required

EXPERIENCE:

• 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 3-5 years of industry experience in Property and Casualty Claims

SKILLS/ABILITIES

• Excellent negotiation skills
• 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

KNOWLEDGE:

• In-depth knowledge of multi-jurisdictional claims handling issues
• PC literate, including Microsoft Office products

ROUTINE DECISIONS AND FORMAL POLICY SETTING:

• Assure that significant financial payments over the course of a year are proper in all respects
• Assure that claims are neither improperly accepted as covered or inappropriately denied