The claims adjuster handles a caseload of approximately 100 pending claims that encompass less complexity. 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 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:
- Identify, analyze, and confirm coverage.
- 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 with 8 business hours.
- Assist management when required with projects as requested.
- Timely refer all files identified with subrogation potential to the subrogation department.
- 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.
- 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.
- 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.
- 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.
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 start date).
- Complete 5 training classes with 80% score (Commercial Auto, Personal Auto, Commercial GL, Residential Property/ Homeowners; Residential Renters)
- Hold or obtain a New York 17-70 adjuster’s license
- 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.
- Must be able to pass all training courses within 12 months with a score of 80% or above.
- 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 condition
- Requires lifting of files and boxes up to approximately 20 pound
- Repeated use of a keyboard, mouse, and exposure to computer scre