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Claims - General Liability Construction Defect Claims Adjuster - Remote

Employer
NARS
Location
Nationwide
Salary
Not specified
Closing date
Jul 9, 2021

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Job Details

Job Description:

Must have Construction Defect experience.

Claim metrics must be kept current. Handle a caseload up to 150 pending claims that may include some levels of complexity. Requires establishing facts of loss, coverage analysis, investigation/ compensability/liability/negligence determination, coordination of medical care (as appropriate), litigation management, damage assessment, settlement negotiations, identifying potential fraud and appropriate use of authorized vendors. Also includes timely and appropriate reserve analysis and report completion. Ability to attend conferences, client meetings, mentor other adjusters and assist management as requested. All file handling must be within state statutes, Client Claims Handling Guidelines and NARS Best Practices. Other miscellaneous duties as assigned, which may include travel.

Essential Duties and Responsibilities: Coverage:

• Identify, analyze and confirm coverage. Customer Service/Contact:

• Make first contact within parties and client within 8 business hours.

• Contact appropriate parties and providers to determine liability, compensability, negligence and subrogation potential.

• Contact appropriate parties to obtain any needed information and explain benefits as appropriate. Continue contact throughout the life of the file as appropriate.

• Answer phones, check voice mail regularly, and return calls as needed. • Assist with training/mentoring of Claims Adjusters.

• Assist management when required with projects or leadership as requested.

• Handle the various duties/responsibilities of the Assistant Unit Manager/Unit Manager as delegated in their absence.

Subrogation:

• Refer all files identified with subrogation potential to the subrogation department.

Investigation:

• Verify facts of loss and pertinent claims facts such as employment, wages, or damages and establish disability with treating physicians as appropriate.

• Identify cases for settlement. Evaluate claims and request authority no later than 30 days prior to mediation date and negotiate settlement.

• Evaluate and negotiate liens.

• Recognize and report potential fraud cases.

Litigation Management:

• Develop and direct a litigation plan with defense attorney (if assigned), utilizing all defenses and tools to bring the file to closure. Ensure all filings and state mandated forms are completed timely. Litigated files must be diaried effectively based on current activity, but no greater than every 60 days.

• Review claim files involving active litigation on a monthly basis at minimum, and document responses to filings, development of defenses, depositions, and timely referral to defense counsel.

• Direct the actions of defense counsel on litigated files.

• Attend mediations and trials as required for cost effective litigation management.

Reserves:

• Establish ultimate reserves (anticipated cost to bring file to close based on known facts) as soon as practical and monitor to adjust at the time of any exposure changing event.

• Pay all known benefits, ensuring they are paid timely on state statute.

• Verify all provider bills have been appropriately reviewed and paid within standard timeframes.

Reporting Requirements:

• Report all serious injuries/liability issues and potential large loss claims to the client and/or reinsurer based upon the criteria provided by the client.

• Must pass all internal and external audits, which include those performed by regulatory agencies, carriers, and clients.

• Follow reporting requests as outlined by client files and NARS guidelines.

Resolution:

• Document plan of action in the claim system and set appropriate diaries.

• Maintain a regular diary for monitoring and directing medical care, case development, or litigation.

• Close all files as appropriate in a timely and complete manner. 

• Maintain closing ratio as dictated by management team.

Qualification Requirements:

Education / Licensing:

• High School Diploma or equivalent required, 2-year degree or higher preferred.

• 2 to 7 years of prior claim adjusting experience or have successfully completed the NARS Claims Trainee program.

• Must possess, or have the ability to obtain, a Florida Adjuster’s license or other required jurisdictional licensing. Technical skills:

• Must have interpersonal skills to handle sensitive and confidential situations and information.

• Requires ability to negotiate claims and to direct litigation.

• Must have negotiation and litigation skills for significant work with attorneys and arbitration on first and third- party claims.

• Requires ability to work independently.

• Requires organization and time management skills.

• Must possess written and verbal communication skills.

• Must be able to explain and appropriately respond to auditors, clients, and potential clients during in-person presentations.

Abilities:

• Requires long periods of sitting.

• If you live within 25 miles of an office, you will be required to commute and work out of that office.

• Requires working indoors in environmentally controlled conditions.

• Requires lifting of files and boxes up to approximately 20 pounds.

• Repeated use of a keyboard, mouse, and exposure to computer screens.

• Requires travel as assigned, which can at times be extensive (5 to 7 days per month).

General Information: The above statements are intended to describe the general nature and level of work being performed by individuals assigned to this position. This description reflects management’s assignment of essential functions; it does not prescribe or restrict the tasks that may be assigned. The incumbent must be able to work in a fast-paced environment with demonstrated ability to handle multiple, competing tasks and demands and to seek supervisory assistance when necessary. Incumbents within this position must abide by basic workplace safety procedures and adhere to the standards of conduct set forth in the North American Risk Services, Inc. Employee Handbook. In addition, you may be required to assist or find appropriate assistance to make accommodations for disabled individuals in order to ensure access to the organization’s services (may include: visitors, employees or others).

Company

North American Risk Services (NARS) is a premier third-party claims administrator that is dedicated to producing the best possible results for our clients. Founded in 1996, we handle claims for insurers, brokerages, managing general agencies, reinsurers, liquidation bureaus, self-insured funds and entities.

Our staff is among the industry's most experienced, and our technology is unsurpassed. Through our people, technology, workflows, and protocols, we are committed to providing the best claims administration and management available.

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