About this role
- Plans and conducts investigations of claims (including such activities as interviewing insureds, witnesses and claimants, collecting and evaluating appropriate documentation and securing evidence and protecting the chain-of-custody) to analyze and confirm coverage and to determine liability, compensability and damages.
- Determines need for, and engages independent adjusters, cause and origin experts and independent medical examiners.
- Refers to claim to subrogation group or Special Investigations Unit as appropriate.
- Assesses policy coverage for submitted claims and notifies the insured of any issues; determines and establishes reserve requirements, adjusting reserves, as necessary, during the processing of the claim.
- Assesses actual damages associated with claims and conducts negotiations, within assigned authority limits, to settle claims.
- Coordinates the litigation activities associated with assigned claims to ensure a timely and cost-effective resolution; attends trials as a representative of the company.
- Acts as senior technical professional on team, assisting team members with escalated issues.
- Mentors and trains new team members.
- Participates in Quality Review process.
- Participates in conducting Suit Committees, Roundtables, Arbitrations, Mediations, field investigations and may assist in conducting closed file reviews.
- Performs other duties as assigned.
- BS/BA degree or equivalent work experience.
- Minimum of 2 years experience in claims adjustment, general insurance or formal claims training.
- Required to obtain and maintain all applicable licenses.
- Continuing education courses leading to industry certifications preferred (e.g., AEI, IIA, CPCU).
- Knowledge of claims investigation techniques, medical terminology and legal aspects of claims.