Investigates, evaluates and resolves complex liability and first party property claims. Collaboration with vendors for claims resolution, which can include but is not limited to field adjusters, attorneys, and external claim experts. Ensures that prompt and courteous handling of claims is provided to policyholders and claimants. Acts in accordance as the primary handler for all assigned files.
Claim Assignment
Receives new losses and/or reassigned files to handle directly. Engages vendors as required per the circumstances of the file. Ensures prompt contact is made as per established guidelines. Works pending claims to ensure efficient completion. Reviews policy information to determine applicable coverage(s). Makes recommendations to the manager for resolution of coverage issues in accordance with policy language, customer and company guidelines, and established best claims handling procedures.
Investigation
Ensures investigations are completed timely, including but not limited to obtaining recorded statements, damage estimates, authority reports, proofs of loss, photos, medical bills, medical reports, and any investigation reports needed to evaluate damages. Provides guidance to vendors on an ongoing basis, making recommendations as needed to facilitate final claim disposition. Presents information in a thorough manner and participates in their discussions when escalated.
Reserves
Recommends timely and accurate reserves based on the investigation and inspections, in accordance with established guidelines and best claim handling practices to ensure sufficient funds can be allocated to cover potential losses. Monitors reserves as the claims progress and makes adjustments as circumstances warrant.
Claim Resolution
Evaluates claim investigative material and obtains sufficient information for the negotiation of prompt and equitable settlements and/or resolution of the claims. Responsible for staying current on legal trends and adhering to statutes that affect claim handling in the appropriate state(s).
Reporting
Maintains a current diary on each claim to ensure timely resolution and closing of the file. Provides detailed captioned reports for management review on major losses. Works efficiently in multiple platforms. Consistently follows up with engaged parties as needed. Ensures files are fully documented and able to support the claim decision.
Customer Service
Ensures prompt, proper contact is made and maintained with customers, insureds, agents, claimants, Public Adjuster’s and attorneys.
Training
Assists the claims supervisor or manager as needed in mentoring less experienced examiners. Assists in identifying training needs.
Requirements
•4-year college degree plus 7 years of liability claims handling experience and 5 years of first party property claims handling experience, or a comparable combination of education and experience.
•Working knowledge and in-depth experience interpreting and adjusting property damage estimate.
•Able to interpret policy coverages applicable to the lines of business.
•Working knowledge and in-depth experience evaluating liability exposures, reading, comprehending medical records and all related expert reports as they apply to the claims handling process.
•Computer literacy and ability to use applicable software. Preferred experience with Guidewire, MSP Navigator, Xactimate and office 360.
•Adjusters home state license required and the ability to obtain any additional state licenses as required.
•Insurance certificates, courses, or professional designations a plus.
•Proven and effective negotiation skills
Job Type: Contract
Pay: $35.00 - $50.00 per hour
Work setting:
Work Location: Remote