Description
Job Description:
Handle a caseload commensurate with the complexity level of claims assigned. The position requires establishing facts of loss, coverage analysis, investigation, /liability/negligence determination, damage assessment, settlement negotiations, identifying potential fraud, and appropriate use of authorized vendors. The adjuster trainee must also complete a timely and appropriate reserve analysis. All file handling must be within state statutes, Client Claims Handling Guidelines, and NARS Best Practices.
Essential Duties and Responsibilities:
Coverage:
- Identify, analyze, and confirm coverage.
Customer Service/Contact
- 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 within 8 business hours.
- Assist management when required with projects as requested.
Subrogation:
- Timely refer all files identified with subrogation potential to the subrogation department.
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 and negotiate settlement.
- Recognize and report potential fraud cases.
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.
- Verify all provider bills have been appropriately reviewed and paid within standard timeframes.
Reporting Requirements:
- 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.
Resolution:
- Document plan of action in the claim system and set appropriate diaries.
- Maintain a regular diary and follow up as required.
- Close all files as appropriate in a timely and complete manner.
- Maintain 1:1 closing ratio.
- Other jobs duties as assigned.
Qualification Requirements:
Education / Licensing:
- High School Diploma, 2-year college degree preferred.
- Must possess a Florida Adjuster’s license or other required jurisdictional licensing. (Or be willing, as a condition of employment, to obtain one within 30 days of the start date).
- Hold or obtain a New York 17-70 adjuster’s license.
Technical Skills:
- Advance level of interpersonal skills to handle sensitive and confidential situations and information.
- Requires advanced ability to negotiate claims.
- Requires advanced ability to work independently.
- Requires an advanced level of organization and time management skills.
- Must possess advanced level written and verbal communication skills.
- Must be able to explain and appropriately respond to auditors, clients, and potential clients during in-person presentations.
Abilities:
- Must be able and agree to work overtime as needed, especially during a catastrophe.
- Requires long periods of sitting.
- Requires working indoors in environmentally controlled conditions
- Requires lifting of files and boxes up to approximately 20 pound
- Repeated use of a keyboard and mouse and exposure to computer screens.