Senior Construction Defect Claims Adjuster - Work from Home

Claim metrics must be kept current. Handle a caseload commensurate with the complexity level of claims assigned.  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 eight 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. Maintain closing ratio as dictated by management team.  Close all files as appropriate in a timely and complete manner.

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.