Oversee a unit of CAT desk adjusters and/or other vendor supervisory staff of CAT desk adjusters, and assist with training, technical guidance, and reporting to internal and external customers. Oversee all aspects of file handling on new and pending claims which includes: facts of loss, coverage analysis, investigation, negligence/compensability/liability determinations, damage assessment and coordination of medical care as appropriate. Approve and monitor litigation management, settlement negotiations, and appropriate use of vendor table. Establish and approve reserves as needed, as well as coverage issues and determinations. Ability to attend conferences, client meetings, mentor adjusters and assist management as requested. Ensure files assigned to the unit are handled within state statutes, Client Claims Handling Guidelines and NARS Best Practices. Other miscellaneous duties as assigned, which may include travel.
Essential Duties and Responsibilities:
- Effectively supervise unit of claims personnel and their respective caseloads in a proactive manner.
- Adhere to all file handling standards, NARS Best Practices, Client standards, state statutes and requirements necessary to pass audits performed by regulatory agencies, carriers and clients. Form well written emails and LLR’s internally and externally.
- Manage to performance measures, including cycle times, closure rates, average paid, expense paid, reserve accuracy, and other areas relevant to each program managed.
- Demonstrate a strong commitment to the mission and values of the organization.
- Maintain strict confidentiality of client, company and personnel information.
- Work closely with Quality Assurance to ensure company objectives are met.
- Review and respond to claim appeals and grievances, investigate and respond to complaints.
- Lead and manage by example to promote culture of service and continuous improvement and to achieve key business goals.
- Assign accountability for desired outcomes and hold adjusters to required dates.
- Communicate clearly and provide adequate direction.
- Track trends by program and unit – know the team’s claims when a client asks.
- Know the Team’s Clients and be able to confidently discuss their claims.
- Effectively manage corrective action processes in accordance with Human Resource guidelines.
- Participate in the effective recruitment of top candidates.
- Participate in development and implementation of training programs.
- Maintain knowledge of current industry developments, case law changes and best practices.
- Implement specific and unique client CAT guidelines/protocols and reporting standards.
- Triage and report all suits, time limit demands, and mediations.
- Ensure that the team adequately licensed.
- CAT claims that impacts our clients, as well as long term disputed and re-opened claims.
- Must be available 24/7 for potential emergency claims.
- Manage desk adjusters to ensure timely assignments, contacts, reserve set-up, ISO reporting, return of and processing estimates, and customer contact/payments, as well as coverage issue recognition and resolution.
- Manage independent adjusters to ensure timely appraisal/QA completion, and correction of estimates as necessary.
- Integrate with other operational units as needed during periods of CAT inactivity.
- Assist the CAT Director with vendor meetings/screening.
- Responsible for overseeing adequate reserving of claims files and quality and efficient claim handling of files assigned to unit.
- Maintain appropriate diary on pending claims within the unit and ensure same for employees.
- Handle performance evaluations, if necessary, attendance reporting and miscellaneous personnel issues.
- Conduct periodic one-on-one meetings to discuss goals/aspirations and SCORE, C3 diary, Skill set analysis to define strengths/ weaknesses & development needs.
- Conducting audits of adjusters, (2 files per month per adjuster).
- Routine analysis of pending and staffing for timely redistribution or requisitions, hiring, training and development.
- Create Individual Development plans and written training plans where appropriate.
- Coordinate HR functions with HR and the Department Director regarding progressive discipline.
- Conduct monthly Unit meetings to cover successes and areas of opportunity for improvement.
- Complete employee PE reviews within requested time frame with IDP and training plans included. Follow up with employee if not meeting deadline.
Litigation, Mediation and Appraisal:
- Coordinate first and third party claim settlements with carriers, re-insurer or plan administrators.
- Control and direct activities of defense counsel either directly or indirectly through staff.
- Responsible for approval of the assignment of legal defense of claims, as approved by clients.
- Responsible for appropriate unit activities as relate to the litigation process, timely reporting of litigated files to management and round table discussions.
- Responsible for client satisfaction, claim reviews and audit results for the unit.
- Handle all miscellaneous assigned duties and projects as assigned by management.
- Ensure program management, carriers and/or re-insurer receive appropriate claim notifications and referrals on large or potential large claims.
- Resolve customer and insurance department complaints according to Best Practices, monitoring customer satisfaction in an effort to drive action plans for improvement.
- Follow up with Director on client issues and action plan for results on issues.
- Conduct regular file reviews/audits for trend detection and correction of negative trends.
- Review/approve all SIU referrals. Complete reports as necessary.
- College Degree or equivalent experience required.
- Must have 10+ years of overall claims and litigation experience, preferably in the line of business being handled.
- Must have 5+ years Claims Supervisory experience or similar/related experience in the appropriate field including restaurant/premises, product liability experience.
- Must be eligible for reserve/payment authority level of $100,000+ (where client appropriate).
- Must possess, or have the ability to obtain a Florida Adjuster’s license or other required jurisdictional.
- Valid driver’s license.
- Advanced level of interpersonal skills to handle sensitive and confidential situations and information.
- Requires advanced technical skills and ability to assist claims unit adjusters with litigation/mediation/appraisal direction and settlement negotiations with attorneys and arbitrators on first party claims.
- Advanced ability to work independently.
- Advanced level of organization and time management skills.
- Advanced level written and verbal communication skills.
- Must be able to analyze claims data and explain and appropriately respond to auditors, clients and potential clients during in-person presentations.
- Advanced knowledge of a variety of computer software applications in word processing spreadsheets, database and presentation software (Microsoft Office platform).
- Must have solid technical skills in claims handling matters. Experienced with building codes, and proficient with Xactimate and XactAnalysis, and ability to learn and operate in Symbility.
- Requires some travel including overnight and weekends as needed.
- Willingness to work flexible hours.
- May involve driving a motor home to and assistance with client “CAT villages” following a storm.
- Requires some lifting of boxes (marketing materials and displays) up to approximately 20 pounds.
- Ability to persuade and influence others.
- Ability to develop and deliver presentations.
- Ability to create, compose and edit written materials.
- Must be available 24/7 for potential emergency claims.
- Repeated use of keyboard, mouse and exposure to computer screens from either a desktop or laptop computer.
- Requires long periods of sitting.