Description
Handle a caseload commensurate with the complexity level of claims assigned. Responsibilities include investigating loss, determining coverage, coordinating medical care, managing litigation, assessing damages, negotiating settlements, identifying fraud, and utilizing authorized vendors. Ensure compliance with state statutes, client guidelines, and best practices. Attend conferences, client meetings, mentor other adjusters, and support management as needed. Timely address claim metrics. 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:
• Establish initial contact within parties and client within eight (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. Provide information and maintain regular 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 new Claims Adjusters.
• Assist management when required with projects or temporarily handle assistant manager or manager duties as requested.
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 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 in a timely manner. Litigated files must be diarized effectively based on current activity, but no greater than every 60 days.
• Review claim files involving active litigation monthly 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) promptly.
• Pay all known benefits, ensuring they are paid in a timely manner according to 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.
Qualification Requirements:
Education / Licensing:
• High School Diploma or equivalent required, 2-year degree or higher preferred.
• Must have experience with litigation.
• 3 to 9 years of prior claim adjusting experience or have successfully completed the NARS Claims Trainee program.
• Must possess, or can 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.
• Must have strong 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.
• Requires excellent 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.
• Must be willing to attend local NARS office meetings, on occasion.
• Requires working indoors in environmentally controlled conditions.
• May require lifting of files and boxes up to approximately 20 pounds.
• Regular use of keyboard, mouse, computer, and exposure to computer screens.
• Requires travel for mediation, as assigned.