Job Description
Why Work Here?
100% Remote Work: Enjoy the flexibility of working from home.
Excellent Benefits: Comprehensive benefits package, including medical, dental, and vision insurance starting on your first day—no waiting period!
Work-Life Balance: We prioritize your well-being with a healthy work-life balance.
Professional Growth: Opportunities for career advancement and skill development.
Job Description
As a Claims Adjuster, you will manage a caseload of up to 150 pending claims, which may involve varying levels of complexity. This role requires you to establish facts of loss, analyze coverage, conduct investigations, assess compensability, and determine liability and negligence. You'll coordinate medical care as needed, manage litigation, assess damages, negotiate settlements, and identify potential fraud.
In this role, you'll also be responsible for maintaining timely and accurate reserve analysis and reporting, attending conferences, client meetings, mentoring other adjusters, and assisting management when needed. All tasks must comply with state statutes, client claims handling guidelines, and best practices.
Essential Duties and Responsibilities
Coverage:
Assess and confirm the coverage for each claim.
Customer Service & Communication:
Initiate first contact with clients and parties within 8 business hours.
Coordinate with relevant parties to determine liability, compensability, and potential subrogation.
Maintain communication throughout the claim's lifecycle, providing necessary updates and explanations of benefits.
Respond promptly to phone calls, check voicemail regularly, and return messages as needed.
Assist in training and mentoring junior claims adjusters.
Support management with various tasks or leadership responsibilities when required.
Step in to manage duties of the Assistant Unit Manager or Unit Manager during their absence.
Subrogation:
Refer claims with subrogation potential to the appropriate department.
Meet closure ratios as determined by management.
Ensure timely and thorough closure of all claims.
Investigation:
Verify facts related to the loss, including employment, wages, damages, and disability status.
Identify claims that may be suitable for settlement and seek approval for settlement authority.
Negotiate settlements and resolve liens.
Identify and report potential fraud.
Litigation Management:
Collaborate with defense counsel to develop and implement a litigation strategy, utilizing available defenses to bring claims to closure.
Ensure all filings and state-mandated forms are submitted on time.
Review litigated claims monthly and document progress, including responses to filings, development of defenses, and referrals to defense counsel.
Attend mediations and trials as necessary for cost-effective litigation management.
Reserves:
Set initial reserves based on known facts and adjust them as necessary when new information arises.
Ensure timely payment of benefits in compliance with state statutes.
Review and pay provider bills within the established timeframes.
Reporting:
Report serious injuries, liability issues, and potential large loss claims to clients or reinsurers based on provided criteria.
Pass internal and external audits, including those conducted by regulatory agencies, carriers, and clients.
Follow reporting protocols as outlined by client files and internal guidelines.
Qualification Requirements
Education & Licensing:
High school diploma or equivalent required; 2-year degree or higher preferred.
7+ years of experience in claims adjusting, preferably in the relevant line of business.
Minimum of 7 years of heavy litigation experience for all lines except Worker's Compensation.
Minimum of 5 years of experience with construction defect or similar claims (if handling that line).
Eligible for reserve/payment authority of $50,000 or more.
Ability to obtain and maintain the necessary state adjuster's license or other required jurisdictional licenses.
Technical Skills:
Strong negotiation skills to manage claims and direct litigation.
Excellent interpersonal skills to handle sensitive and confidential information.
Ability to manage a caseload efficiently and make sound decisions regarding claims handling.
Employment Type: Full-Time
Salary: $ 75,000.00 130,000.00 Per Year
Job Tags
Full time, Remote job, Work from home,