“This role is currently work-from-home and will move to the office environment after the COVID-19 restrictions are lifted.”
Location: Remote, Must work in EST timezone
Requirements:
- 1-2+ years of experience
- Prior workers compensation claims adjusting experience
- Must be licensed in the one or all of the following states: Florida, Georgia, North or South Carolina
The Claims Specialist works within a Claims Team, using the latest technology to review, analyze and process claims that are routinely characterized as moderately complex to complex within assigned authority limits. This includes making decisions about liability/compensability, evaluating losses, negotiating settlements and managing an inventory of commercial property/casualty claims involving bodily injury or property loss. The Claims Specialist may also assist the Claims Team Manager with assigning new claims to team members, providing technical direction, and monitoring caseloads.
Responsibilities:
• Plans and conducts investigations of claims (including such activities as interviewing insureds, witnesses and claimants, collecting and evaluating appropriate documentation and securing evidence and protecting the chain-of-custody) to analyze and confirm coverage and to determine liability, compensability and damages; determines need for, and engages independent adjusters, cause and origin experts and independent medical examiners. Refers to claim to subrogation group or Special Investigations Unit as appropriate.
• Assesses policy coverage for submitted claims and notifies the insured of any issues; determines and establishes reserve requirements, adjusting reserves, as necessary, during the processing of the claim.
• Assesses actual damages associated with claims and conducts negotiations, within assigned authority limits, to settle claims.
• Coordinates the litigation activities associated with assigned claims to ensure a timely and cost-effective resolution; attends trials as a representative of the company.
• Acts as technical professional on team, assisting team members with escalated issues. Mentors and trains new team members. Participates in Quality Review process.
• Participates in conducting Suit Committees, Roundtables, Arbitrations, Mediations, field investigations and may assist in conducting closed file reviews.
• Performs other duties as assigned.
Qualifications:
• 1-2+ years claims adjusting experience.
• Demonstrates an advanced to expert level knowledge of claims case handling practices, legal liability, general insurance policy coverage, and the State's tort laws.
• Excellent interpersonal skills to communicate and negotiate with customers and conduct investigations required.
• Leadership ability and demonstrated time management skills to delegate work appropriately and organize resources effectively.
• Required to obtain and maintain all applicable licenses. Continuing education courses leading to industry certifications preferred (e.g., AEI, IIA, CPCU).
The ideal candidate would have experience in FL, GA, NC, SC and have 5-7 plus years of experience with limited job hopping.
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